INCREASED MORTALITY AFTER SUCCESSFUL TREATMENT FOR HODGKINS-DISEASE

Purpose: To determine the impact of treatment toxicity on long-term su rvival in pediatric Hodgkin's disease. Patients and Methods: We studie d late events in 387 patients treated for pediatric Hodgkin's disease on four consecutive clinical trials at St Jude Children's Research Hos pital from 1968 to 1990. Relative risks, actuarial risks, and absolute excess risks for cause-specific deaths were calculated. Results: As o f April 1997, 316 (82%) of patients were alive, with a median follow v p of 15.1 (range, 2.9 to 28.6) years. In this cohort, which represente d 5,623 person-years of follow-up, 71 fatal events resulted from Hodgk in's disease (n = 36), second malignancies (n = 14), infections (n = 7 ), accidents (n = 7), cardiac disease (n = 6), and asphyxiation (n = 1 ). The 5-year estimated event-free survival (EFS) for the entire cohor t was 79.6% +/- 2.1%, which declined to 63.1% +/- 4.4% by 20 years. Cu mulative incidences of cause-specific deaths at 25 years were 9.8% +/- 1.6% for Hodgkin's disease, 8.1% +/- 2.6% for second malignancy, 4.0% +/- 1.8% for cardiac disease, 3.9% +/- 1.5% for infection, and 2.1% /- 0.8% for accidents. Standardized incidence ratios showed excess ris k for all second malignancies (12; 95% confidence interval [CI], 8 to 17), acute myeloid leukemia (81;95% CI, 16 to 237), solid tumors (11;9 5% CI, 7 to 16), and breast cancer (33; 95% CI, 12 to 72), Standardize d mortality ratios also showed excess mortality from cardiac disease ( 22; 95% CI, 8 to 48) and infection (18; 95% CI, 7 to 38). Conclusion: Compared with age- and sex-matched control populations, survivors of p ediatric Hodgkin's disease who were treated before 1990 face an increa sed risk of early mortality related to second cancers, cardiac disease , and infection. (C) 1998 by American Society of Clinical Oncology.