scholarly journals Erythrocyte mean corpuscular volume during cytotoxic therapy is a predictive parameter of secondary leukemia in Hodgkin's disease

Cancer ◽  
1987 ◽  
Vol 59 (2) ◽  
pp. 301-304 ◽  
Author(s):  
Aimery De Gramont ◽  
Christophe Louvet ◽  
Marcel Krulik ◽  
Nicole Smadja ◽  
Daniel Donadio ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Mean Corpuscular Volume ◽  
Hodgkin’S Disease ◽  
Corpuscular Volume ◽  
Secondary Leukemia ◽  
Cytotoxic Therapy

Secondary Leukemia following Treatment for Hodgkin's Disease

1993 ◽  
Vol 79 (2) ◽  
pp. 103-107 ◽  
Author(s):  
Luigi Salvagno ◽  
Lorenzo Simonato ◽  
Mariella Sorarù ◽  
Antonio Bianco ◽  
Vanna Chiarion-Sileni ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Odds Ratio ◽  
Case Control Study ◽  
Hodgkin’S Disease ◽  
Treatment Modalities ◽  
Secondary Leukemia ◽  
Increased Risk ◽  
Radiotherapy Alone ◽  
One Year ◽  
Control Study

Aims and Background Patients treated for Hodgkin's disease with chemotherapy or with the association of chemotherapy and radiotherapy have an increased risk of secondary leukemia. The aim of this study was to evaluate the leukemogenic risk due to these treatment modalities. Methods We performed a case-control study on a population of 1410 patients treated for Hodgkin's disease from 1970 to 1990 in our Institute. Among these patients, we identified 25 cases of secondary leukemia and 3 cases of myelodysplasia, all occurring more than one year after the diagnosis of Hodgkin's disease. Three cases occurred among the patients treated with radiotherapy alone. When we analyzed the risk in relation to the type of treatment (radiotherapy, chemotherapy, or both), the comparisons were relative to patients treated with radiotherapy alone. Results We found that chemotherapy alone is associated with a fivefold increased risk (odds ratio = 5.4) compared with radiotherapy alone. When both treatments are used, the risk is not further increased (odds ratio = 4.4). Patients receiving more than 6 courses of chemotherapy have an excess risk (relative risk = 2.5) compared with those treated with 6 courses or less. No increased risk was observed after splenectomy. Conclusions This study confirms an increased incidence of secondary leukemia occurring in patients treated for Hodgkin's disease. The increased risk seems to be correlated with the number of courses of alkylating agent therapy, whereas it is unaffected by the addition of radiotherapy.

Stanford V and Radiotherapy for Locally Extensive and Advanced Hodgkin’s Disease: Mature Results of a Prospective Clinical Trial

2002 ◽  
Vol 20 (3) ◽  
pp. 630-637 ◽  
Author(s):  
Sandra J. Horning ◽  
Richard T. Hoppe ◽  
Sheila Breslin ◽  
Nancy L. Bartlett ◽  
B. William Brown ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Chemotherapy Regimen ◽  
Hodgkin’S Disease ◽  
Prognostic Score ◽  
Secondary Leukemia ◽  
Bulky Disease ◽  
Standard Doxorubicin ◽  
Splenic Disease ◽  
Advanced Hodgkin’S Disease

PURPOSE: To provide more mature data on the efficacy and complications of a brief, dose-intense chemotherapy regimen plus radiation therapy (RT) to bulky disease sites for locally extensive and advanced-stage Hodgkin’s disease. PATIENTS AND METHODS: One hundred forty-two patients with stage III or IV or locally extensive mediastinal stage I or II Hodgkin’s disease received Stanford V chemotherapy for 12 weeks followed by 36-Gy RT to initial sites of bulky (≥ 5 cm) or macroscopic splenic disease. Freedom from progression (FFP), overall survival (OS), and freedom from second relapse (FF2R) were determined using life-table estimates. Outcomes were analyzed according to the international prognostic score. Late effects of treatment were recorded in follow-up. RESULTS: With a median follow-up of 5.4 years, the 5-year FFP was 89% and the OS was 96%. No patient progressed during treatment, and there were no treatment-related deaths. FFP was significantly superior among patients with a prognostic score of 0 to 2 compared with those with a score of 3 and higher (94% v 75%, P < .0001). No secondary leukemia was observed. To date, there have been 42 pregnancies after treatment. Among 16 patients who relapsed, the FF2R was 69% at 5 years. CONCLUSION: These data confirm our preliminary report that Stanford V chemotherapy with RT to bulky disease sites is highly effective in locally extensive and advanced Hodgkin’s disease. It is most important to compare this approach with standard doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy in the ongoing intergroup trial (E2496) to determine whether Stanford V with or without RT represents a therapeutic advance.

Assessing the Risk of Secondary Leukemia in Patients Treated for Hodgkin's Disease — A Report from the International Database on Hodgkin's Disease

1997 ◽  
Vol 05 (03) ◽  
pp. 433-444 ◽  
Author(s):  
A. D. Tsodikov ◽  
M. Loeffler ◽  
A. Yu. Yakovlev
Keyword(s):  
Data Base ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Parametric Models ◽  
International Database ◽  
Secondary Leukemia ◽  
Relapse Treatment ◽  
International Data ◽  
Overall Risk

Parametric models are used to investigate the time of leukemia latency in patients treated for Hodgkin's disease. A model of induced carcinogenesis provides a stable projection of the leukemia risk for times beyond the follow-up period. The model is applied to data collected in the International Data Base on Hodgkin's Disease. It permits to estimate the contributions of primary and of relapse treatment to the overall risk of induced leukemia. Latency periods appear to be identical after both treatments supporting the concept of induced leukemogenesis.

Risk of subsequent malignant neoplasms among 1,641 Hodgkin's disease patients diagnosed in childhood and adolescence: a population-based cohort study in the five Nordic countries. Association of the Nordic Cancer Registries and the Nordic Society of Pediatric Hematology and Oncology.

1996 ◽  
Vol 14 (5) ◽  
pp. 1442-1446 ◽  
Author(s):  
R Sankila ◽  
S Garwicz ◽  
J H Olsen ◽  
H Döllner ◽  
H Hertz ◽  
...  
Keyword(s):  
Relative Risk ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Cancer Registries ◽  
Incidence Rates ◽  
Nordic Countries ◽  
Malignant Neoplasms ◽  
Childhood And Adolescence ◽  
High Relative Risk ◽  
Secondary Leukemia

PURPOSE To assess the risk of subsequent malignant neoplasms among Hodgkin's disease patients diagnosed before 20 years of age in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). PATIENTS AND METHODS There were 1,641 Hodgkin's disease patients identified through the national cancer registries since the 1940s or 1950s. The patients were monitored for 17,000 person-years until the end of 1991. Expected figures were derived from the age-specific incidence rates in each country and standardized incidence ratios (SIR) were calculated. RESULTS A total of 62 subsequent neoplasms were diagnosed (SIR, 7.7; 95% confidence interval [CI], 5.9 to 9.9). The overall cumulative risk of subsequent neoplasms was 1.9% at the 10-year follow-up point, 6.9% at 20 years, and 18% at 30 years. There were 26 subsequent neoplasms among males (SIR, 6.5; 95% CI, 4.3 to 9.6) and 36 among females (SIR, 8.9; 95% CI, 6.2 to 12), of which 16 were breast cancers (SIR, 17; 95% CI, 9.9 to 28). High risks were seen for thyroid cancer (SIR, 33; 95% CI, 15 to 62), for secondary leukemia (SIR, 17; 95% CI, 6.9 to 35), and for non-Hodgkin's lymphoma (SIR, 15; 95% CI, 4.9 to 35). The relative risk increased from 3.3 (95% CI, 1.2 to 7.1) for Hodgkin's disease patients diagnosed in the 1940s and 1950s to 15 (95% CI, 7.4 to 27) in the 1980s. The highest risk of secondary leukemia (SIR, 68; 95% CI, 18 to 174) was seen among those diagnosed with Hodgkin's disease in the 1980s. CONCLUSION Patients who survive Hodgkin's disease at a young age are at very high relative risk of subsequent malignant neoplasms throughout their lives. In particular, the high relative risk of breast cancer following Hodgkin's disease in the teenage years calls for enhanced activity for early diagnosis.

Splenectomy and the increasing risk of secondary acute leukemia in Hodgkin's disease.

1993 ◽  
Vol 11 (5) ◽  
pp. 925-930 ◽  
Author(s):  
S Tura ◽  
M Fiacchini ◽  
P L Zinzani ◽  
E Brusamolino ◽  
P G Gobbi
Keyword(s):  
Hodgkin's Disease ◽  
Proportional Hazards ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Secondary Leukemia ◽  
Proportional Hazards Regression ◽  
Combined Modality ◽  
Leukemia Development ◽  
Increasing Risk

PURPOSE Following irradiation alone, secondary acute nonlymphocytic leukemia (ANLL) is uncommon; following chemotherapy alone, the risk is increased, but not as much as when combined modality treatments are used. Because ANLL seems more likely to occur in splenectomized patients, attention is focused on an unexpected association between splenectomy and the risk of secondary leukemia. PATIENTS AND METHODS The risk of ANLL was assessed in 503 patients with Hodgkin's disease (HD) homogeneously treated with combined modality therapy (mechlorethamine, vincristine, procarbazine, and prednisone [MOPP] plus radiotherapy). These patients were diagnosed from 1970 through 1984 and monitored until June 1991. RESULTS ANLL was observed in one of 145 (0.69%) patients not splenectomized and in 21 of 358 (5.86%) splenectomized patients, demonstrating a significantly higher frequency of ANLL in the group of patients who underwent splenectomy. The group of patients who developed ANLL received a statistically greater number of MOPP courses than did the group not developing ANLL. ANLL was statistically more frequent in those patients who received more than four cycles of MOPP. Sex, symptoms, extent of radiotherapy, splenectomy, age, and number of MOPP courses were assessed for their impact on ANLL incidence by multivariate analysis. CONCLUSION Cox's proportional hazards regression showed that splenectomy and, as previously described by others, the number of courses of MOPP are prognostic factors that increase the risk of secondary ANLL in HD patients treated with combined modality therapy. These data raise interesting questions regarding the possible role of the spleen in leukemia development.

ABVD/MOPP and low-dose involved-field radiotherapy in pediatric Hodgkin's disease: the Stanford experience.

1994 ◽  
Vol 12 (10) ◽  
pp. 2160-2166 ◽  
Author(s):  
S P Hunger ◽  
M P Link ◽  
S S Donaldson
Keyword(s):  
Treatment Efficacy ◽  
Hodgkin's Disease ◽  
Low Dose ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Stage Iv ◽  
Secondary Leukemia ◽  
Bulky Disease ◽  
Entire Cohort ◽  
Stage Iv Disease

PURPOSE We reported previously that treatment with six cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy and 15 to 25 Gy irradiation was effective in curing children with Hodgkin's disease, but was associated with a 6.5% 10-year risk of development of secondary leukemia. Based on the results of that study, a successor study was designed with the objective to maintain treatment efficacy while decreasing adverse effects, particularly the occurrence of secondary leukemia. PATIENTS AND METHODS Fifty-seven children with a chronologic and/or bone age less than 16 years were enrolled onto this study between May 1982 and October 1990. Treatment consisted of six cycles of combination chemotherapy--three of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and three of MOPP--and low-dose irradiation (15 Gy) of involved fields. Boosts of 10 Gy were given to areas of bulky disease and to those that did not respond completely after two cycles of chemotherapy. RESULTS With a median follow-up duration of 6.7 years, the projected 10-year survival and event-free survival (EFS) rates are 96% (SE 2.5%) and 93% (SE 3.5%) for the entire cohort of 57 patients, and 85% (SE 10%) and 69% (SE 12.8%), respectively, for 13 patients with stage IV disease. No patient has developed a second malignancy. Growth and development have progressed normally. No patients have symptomatic cardiac, pulmonary, or thyroid disease. Subclinical abnormalities of pulmonary function were detected in 32% and chemical hypothyroidism in 16%. CONCLUSION This therapy was highly efficacious in children with Hodgkin's disease without unacceptable toxicity. Future efforts should be directed toward further reducing therapy for favorable early-stage patients and improving treatment efficacy for those with stage IV disease.

Marrow transplantation for acute nonlymphocytic leukemia following therapy for Hodgkin's disease.

1987 ◽  
Vol 5 (5) ◽  
pp. 731-734 ◽  
Author(s):  
M Sargur ◽  
C D Buckner ◽  
F R Appelbaum ◽  
P Stewart ◽  
H J Deeg ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Marrow Transplantation ◽  
Hodgkin’S Disease ◽  
Multiorgan Failure ◽  
Remission Induction ◽  
Acute Nonlymphocytic Leukemia ◽  
Secondary Leukemia ◽  
Successful Induction ◽  
First Remission ◽  
Total Body

Seven patients with acute nonlymphocytic leukemia (ANL) following therapy for Hodgkin's disease (HD) were treated with cyclophosphamide (Cy) alone or combined with 10.00 to 15.75 Gy total body irradiation (TBI) and marrow transplantation. Five patients were transplanted without an attempt at prior remission induction, one patient following failure of remission induction and one patient in first remission following successful induction. Four patients died of multiorgan failure, 15 to 70 days after transplant. Three patients died of progressive or recurrent leukemia 56, 120, and 280 days after transplant. These results illustrate the difficulty of treating patients for secondary leukemia with marrow transplantation and suggest that transplantation in the preleukemic phase should be studied.

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