SUBSEQUENT MALIGNANCIES IN CHILDREN AND ADOLESCENTS AFTER TREATMENT FOR HODGKINS-DISEASE

Purpose: We assessed the cumulative risk of malignancies following tre atment for Hodgkin's disease in childhood and adolescence and investig ated related patient and treatment characteristics. Patients and Metho ds: Medical records of 499 Hodgkin's disease patients treated between 1962 and 1993 were reviewed. There were 385 adolescents (greater than or equal to 10 years of age at diagnosis) and 114 preadolescents (< 10 years). Most patients (n = 346) were treated with radiation plus mult iagent chemotherapy, while 30 received only chemotherapy and 123 only radiation therapy. Radiation doses ranged from 20 to 42 Gy. Results: A t a median follow-vp duration of 9 years (range, 0.1 to 27.4), 25 pati ents have had second malignancies: 19 solid tumors, four acute nonlymp hoblastic leukemias (ANLLs), 1 non-Hodgkin's lymphoma (NHL), and one c hronic myeloid leukemia (CML). Three patients have had a third maligna ncy. The estimated cumulative risk of second malignancies increased fr om 1.5% at 5 years to 7.7% at 15 years. All but two of the patients wi th second malignancies were greater than or equal to 10 years of age a t initial diagnosis, which reflects the higher risk among patients tre ated for Hodgkin's disease as adolescents (P = .01). Second malignanci es were more common among female patients (P = .0002), even when those with breast cancer were excluded (P = .007), and in those treated for recurrent Hodgkin's disease (P = .02). patients with ANLL/NHL were ol der at diagnosis of Hodgkin's disease than those with solid tumors, (m edian age, 18.3 v 13.8 years; P = .04). There was no difference betwee n groups treated with radiation therapy alone, chemotherapy alone, or radiation plus multiagent chemotherapy. Conclusion: Adolescents treate d for Hodgkin's disease are at greater at risk of second malignancies than younger patients. Overall, adolescent females treated for recurre nt Hodgkin's disease appear to be at greatest risk, while preadolescen ts appear to be protected from this late complication. (C) 1995 by Ame rican Society of Clinical Oncology.