RISK OF 2ND PRIMARY-CANCER AFTER HODGKINS-DISEASE IN PATIENTS IN THE BRITISH-NATIONAL-LYMPHOMA-INVESTIGATION - RELATIONSHIPS TO HOST FACTORS, HISTOLOGY AND STAGE OF HODGKINS-DISEASE, AND SPLENECTOMY

The risks of second primary cancer were analysed in 2846 patients with Hodgkin's disease treated within the British National Lymphoma Invest igation during 1970-87. The relative risk (RR) of leukaemia was signif icantly greater in women (RR = 30.1; 95% confidence limits (CL) 13.0-5 9.5) than in men (RR = 10.9; 95% CL 4.7-21.5), and showed a significan t trend of greater risk with younger age at first treatment (P<0.001). The relative risk of solid cancers was similar between the sexes, but again significantly greater at young than at older ages of first trea tment (P<0.01). Non-Hodgkin's lymphoma relative risks, although not re lated to sex or age, were significantly related to histology of the or iginal Hodgkin's disease, and were greatest after lymphocyte predomina nt Hodgkin's disease (RR = 55.6; 95% CL 18.0 - 129.7). The relative ri sk of second cancers did not vary significantly according to whether o r not splenectomy had been performed. Leukaemia risk was non-significa ntly greater after splenectomy than with no splenectomy, which accorde d with previous evidence of a modest increased risk associated with th is operation. If the greater relative risk of solid second cancers aft er treatment at young than at older ages persists with longer follow-u p, the incidence rates of these second primaries in patients treated y oung for Hodgkin's disease will become very substantial as they age. T his emphasises the need to maintain long-term follow-up surveillance o f young Hodgkin's disease patients apparently cured of their disease, and to continue to develop new less carcinogenic treatment regimes.