ACUTE NONLYMPHOCYTIC LEUKEMIA - ONSET AFTER TREATMENT FOR HODGKINS-DISEASE

This study was undertaken to examine the influence of various factors on the occurrence of acute nonlymphocytic leukemia (ANLL) in a group o f long-term survivors of Hodgkin's disease (HD). From 1972 to 1992, 10 45 patients with HD were assessed and treated at the Department of Rad iation Oncology, the Institute of Radiology, and the Department of Hum an Biopathology, Hematology Section, University of Pome ''La Sapienza. '' The average follow-up was 72 months. For a more accurate calculatio n of the risk of ANLL occurrence, the patients were first divided into three subgroups according to initial treatment and then according to the total treatment they had received. Moreover, to establish the prob able connection between leukemia and splenic treatment the patients we re also divided into three subgroups (splenectomy, splenic irradiation , and no splenectomy/no splenic irradiation). Sixteen cases of ANLL we re recorded, giving an overall risk of 0.2% at 5 years and 3.4% at 20 years. In 12 patients overt leukemia was preceded by a myelodysplastic syndrome. Five cases had evaluable chromosome analysis. Clonal chromo some abnormalities were demonstrated in two patients, whereas three pa tients showed an apparently normal karyotype. Bone marrow agar culture s were analyzed in two patients and were abnormal in both cases. In th e radiotherapy (RT) group, the cumulative risk was 0.4% at 10 years an d 3.2% at 15 and 20 years; in the chemotherapy (CT) group it was 1.2% at 10, 15, and 20 years; in the combined group it was 3.7% at 10 years and 4.9% at 15 and 20 years. In the multivariate analysis, MOPP treat ment with or without RT is a statistically significant variable for AN LL occurrence (p=0.009). This study demonstrates that splenic treatmen t does not lead to ANLL. Treatment with MOPP alone and with MOPP plus RT can increase the risk of ANLL.