Increased incidence of Hodgkin's disease after allogeneic bone marrow transplantation

Purpose: Immune dysregulation associated with allogeneic bone marrow transp lantation (BMT) is linked to an increased risk of posttransplant lymphoprol iferative disorders (PTLD); however, reports of Hodgkin's disease (HD) afte r transplantation are rare. Patients and Methods: We evaluated the risk of HD among 18,531 persons rece iving allogeneic BMT between 1964 and 1992 at 235 centers. The number of HD cases was compared with that expected in the general population. Risk fact ors were identified using Poisson regression and a nested case-control stud y. Results: Risk of HD was increased in the postBMT population compared with t he general population with an observed-to-expected incidence ratio (O/E) of 6.2 (observed cases, n = 8; 95% confidence interval [CI], 2.7 to 12). A si gnificantly increased risk of HD remained after excluding two human immunod eficiency virus-positive patients (observed cases, n = 6; O/E = 4.7, 95% CI , 1.7 to 10.3). Mixed cellularity subtype predominated (five of eight cares , 63%). Five of six assessable cases contained Epstein-Barr virus (EBV) gen ome, Posttransplant HD differed from PTLD by letter onset (> 2.5 years) and lack of association with established risk factors (such as T-cell depletio n and HLA disparity). Patients with HD were more likely than matched contro ls to have had grade 2 to 4 acute graft-versus-host disease (GVHD), require d therapy for chronic GVHD, or both (P = .002), although analysis included small numbers of patients. Conclusion: The increased incidence of HD among BMT recipients adds support to current theories which link overstimulation of cell-mediated immunity a nd exposure to EBV with various subtypes of HD. The long latency of HD afte r transplant and lack of association with risk factors for PTLD is notewort hy and should be explored further for possible insights into pathogenesis. (C) 1999 by American Society of Clinical Oncology.