Second lethal events associated with treatment for Hodgkin's disease: A review of 2980 patients treated in a single Mexican institute

Presence of second neoplasms and cardiac toxicity has been recognized as po tential late lethal second events in patients treated for Hodgkin's disease . However, most reports analyze these association independently. We reviewe d 2980 cases of patients treated during 1970-1995 with long-term follow-up (> 4 years) in an attempt to identify all late events in Hodgkin's disease secondary to the treatment or those which are unrelated. Three hundred and ten patients died, and of these 156 were secondary to relapse and tumor pro gression. Death associated second tumors and cardiac events were increased 37 fold and 29 fold respectively compared to the general population. The ri sk factors for this complications did not differ to previous reports and in cluded alkylating agents and/or radiotherapy for second neoplasms and anthr acycline therapy and radiotherapy for cardiac toxicity. Moreover, 61 patien ts died secondary to non-related events. Nevertheless, at 20-years overall survival was 90 % (95 % confidence interval (CI): 78 % to 97 %) and event f ree survival was 88 % (95 % CI: 76 % to 96 %) for these patients. Thus, sec ond events, fatal in most cases, should be considered as an expected risk t o the treatment in patients with Hodgkin's disease: the proposed modificati ons of therapy may indeed be useful to avoid or diminish these complication s in the future.