PERSISTENT ABNORMALITIES IN RED-CELL PARAMETERS FOLLOWING TREATMENT OF LYMPHOMA

Patients who have recovered from malignant lymphoma are at an increase d risk of secondary acute leukemia (AL), and overt AL is frequently pr eceded by a myelodysplastic syndrome. Although the statistical risk is significant, only a minority of the patients will be so affected. We have reviewed peripheral blood counts of patients with Hodgkin's disea se (HD) and non-Hodgkin's lymphoma (NHL) treated in the Departments of Hematology at the Edith Wolfson and Chaim Sheba Medical Centers, Isra el. Included were only those who went into a complete remission and re mained lymphoma free for extended periods. There were 85 patients with HD and 36 with NHL. In both groups peripheral blood counts at diagnos is were within the normal range. A prolonged follow-up (>4 y), during which no further treatment was given, revealed a sustained increment o ver time of MCV (Delta MCV) both in HD and NHL. A persistent monocytos is in HD patients was also evident. Delta MCV was larger in HD. The di fference at the end of the follow-up period was as follows: 10.1 fl 11.8 in HD vs 5.0 fl + 6.2 in NHL, (P < 0.001). In addition, a signifi cant loss of the normal correlation between the MCV and levels of hemo globin was seen at the last follow-up. The change in MCV was present i n all treatment groups, its magnitude increasing from radiotherapy to chemotherapy to combined radio chemotherapy. This trend is in analogy to the risk of secondary AL which is lower in NHL vs HD. Furthermore, it is lowest post radiotherapy and highest when both treatment modalit ies are used. In conclusion, the data demonstrate that a form of a pro longed subclinical effect on erythropoiesis is rather a common side ef fect of lymphoma treatment. There is a striking analogy between the ac quired abnormality as seen here and other variables known to be associ ated with the subsequent risk of secondary AL. These results indicate that the treatment of lymphoma commonly induces bone marrow aberration s which are prolonged and of a wider spectrum than hitherto appreciate d.