Analysis of Long-Term Outcome and the Risk of Second Malignancies in Hodgkin Lymphoma Survivors

Background: Therapy of Hodgkin lymphoma (HL) can contribute to delayed impairments of health, which some of them (e.g. secondary cancer) can be fatal.

Aim: The purpose of this retrospective study was to evaluate long-term outcome of HL survivors and the risk of second malignancies.

Methods: The medical report data analysis of 170 patients (pts) with HL treated in one oncological center in Poland between 1979–2005 has been performed. There were 88 females and 82 males, median age 30.5 years (range 16–72). Among the patients there were 22 pts (12.5%) in CSI, 95 pts (55.8%) in CSII, 26 pts (15.4%) in CSIII and 27 pts (15.8%) in CSIV. Half of the 170 pts presented B-symptoms. Chemotherapy (ABVD, MOPP/ABV or MOPP regimen) was given to 155 (93.5%) pts, and radiotherapy alone (mantle-field or involved-field) was given to 11 pts (6.5%). Chemoradiotherapy received 105 pts (61.8%).

Results: CR achieved 136 pts (80%), PR 11 pts (6.4%), and progression of HL was observed in 23 pts (13.5%). With a median follow-up of 242 months (range 0–439), there were 37 relapses (21.7%), and 25 deaths (14.7%), usually due to HL progression (20 pts), and also because of secondary cancer (4 pts = 2.4%) and coronary heart disease (1 patient). Five year DFS and OS were 80% and 90% respectively. There was no statistical difference between ABVD and MOPP/ABV regimen efficacy (p=0.94). Late impairments of health were revealed in 78 pts (45.9%), and there were: secondary malignancies, amenorrhea/infertility, skeletal lesions, depressive syndromes, pulmonary fibrosis, polyneuropathy, hypothyroidism, cardiovascular disease, and gastro-duodenal peptic ulcer. Nine pts (5,3%) developed secondary malignancies, i.e.: 2 melanomas, 2 skin basal-cell carcinomas, 1 osteosarcoma, 1 thyroid carcinoma, 1 non-small cell lung cancer, 1 colon carcinoma, 1 cervical carcinoma, and 1 prostate carcinoma. A median time from the end of the treatment to the development of secondary cancer was 114 months (range 28–434). The risk of secondary malignancies development among pts treated with either initial chemotherapy alone or combined modality therapy was similar, and did not reach statistical significance (p=0.20).

Conclusions: Chemotherapy or chemoradiotherapy of HL provides freedom from the disease in more than 3/4 of our patients. In the group of fairly young patients such treatment caused a substantial amount of variety of health impairments including secondary malignancies. Despite the high rate of HL curability our study indicates the need of a careful, long term medical surveillance of HL survivors.