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Second malignant neoplasms following childhood Hodgkin's disease: treatment and splenectomy as risk factors.
Med Pediatr Oncol. 1989; 17(6):477-84.MP

Abstract

The risk of second malignant neoplasm (SMN) was evaluated in 979 children with Hodgkin's disease. This cohort was diagnosed between 1955 and 1979 at one of the institutions of the Late Effects Study Group. Solid tumors, non-lymphocytic leukemia, and non-Hodgkin's lymphoma (NHL) developed in 18, 17, and 3 patients, respectively. The estimated cumulative probability of developing any SMN was 2% at 5 years from diagnosis, 5% at 10 years, and 9% at 15 years. The incidence is ninefold greater than the risk of acquiring cancer in 19 year-olds, the median age at which the diagnosis of SMN was made in this study population. For leukemia and NHL the corresponding probabilities were 1%, 3%, and 4% for the group as a whole but were increased (2%, 6%, and 8%) in patients who had suffered one or more recurrences. In order to analyze the risk of leukemia and NHL associated with alkylating agent chemotherapy, each patient was assigned a score of one for each alkylating agent administered for a 6-month period. Scores of 2, 4, 6, and 8 were associated with probabilities of leukemia or NHL of 2%, 3%, 6%, and 10%, respectively. In a multivariate analysis for leukemia/lymphoma that included AAD score, stage, and splenectomy, the effect of AAD score and splenectomy did not change substantially compared to the univariate results. AAD score remained statistically significant (P = .0001), and splenectomy was of borderline significance (P = .09). Of the 18 solid tumor SMNs, 15 developed within the field of radiation, and one other developed in tissue irradiated 34 years earlier for hemangioma. This study of a large and unselected group of children with Hodgkin's disease who received a variety of therapies demonstrates that children are as likely as adults to develop acute leukemia after alkylating agents and solid tumors in the field of radiation therapy.

Authors+Show Affiliations

Children's Hospital of Philadelphia, Pennsylvania 19104.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

2586362

Citation

Meadows, A T., et al. "Second Malignant Neoplasms Following Childhood Hodgkin's Disease: Treatment and Splenectomy as Risk Factors." Medical and Pediatric Oncology, vol. 17, no. 6, 1989, pp. 477-84.
Meadows AT, Obringer AC, Marrero O, et al. Second malignant neoplasms following childhood Hodgkin's disease: treatment and splenectomy as risk factors. Med Pediatr Oncol. 1989;17(6):477-84.
Meadows, A. T., Obringer, A. C., Marrero, O., Oberlin, O., Robison, L., Fossati-Bellani, F., Green, D., Vo슩te, P. A., Morris-Jones, P., & Greenberg, M. (1989). Second malignant neoplasms following childhood Hodgkin's disease: treatment and splenectomy as risk factors. Medical and Pediatric Oncology, 17(6), 477-84.
Meadows AT, et al. Second Malignant Neoplasms Following Childhood Hodgkin's Disease: Treatment and Splenectomy as Risk Factors. Med Pediatr Oncol. 1989;17(6):477-84. PubMed PMID: 2586362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Second malignant neoplasms following childhood Hodgkin's disease: treatment and splenectomy as risk factors. A1 - Meadows,A T, AU - Obringer,A C, AU - Marrero,O, AU - Oberlin,O, AU - Robison,L, AU - Fossati-Bellani,F, AU - Green,D, AU - Vo슩te,P A, AU - Morris-Jones,P, AU - Greenberg,M, PY - 1989/1/1/pubmed PY - 1989/1/1/medline PY - 1989/1/1/entrez SP - 477 EP - 84 JF - Medical and pediatric oncology JO - Med. Pediatr. Oncol. VL - 17 IS - 6 N2 - The risk of second malignant neoplasm (SMN) was evaluated in 979 children with Hodgkin's disease. This cohort was diagnosed between 1955 and 1979 at one of the institutions of the Late Effects Study Group. Solid tumors, non-lymphocytic leukemia, and non-Hodgkin's lymphoma (NHL) developed in 18, 17, and 3 patients, respectively. The estimated cumulative probability of developing any SMN was 2% at 5 years from diagnosis, 5% at 10 years, and 9% at 15 years. The incidence is ninefold greater than the risk of acquiring cancer in 19 year-olds, the median age at which the diagnosis of SMN was made in this study population. For leukemia and NHL the corresponding probabilities were 1%, 3%, and 4% for the group as a whole but were increased (2%, 6%, and 8%) in patients who had suffered one or more recurrences. In order to analyze the risk of leukemia and NHL associated with alkylating agent chemotherapy, each patient was assigned a score of one for each alkylating agent administered for a 6-month period. Scores of 2, 4, 6, and 8 were associated with probabilities of leukemia or NHL of 2%, 3%, 6%, and 10%, respectively. In a multivariate analysis for leukemia/lymphoma that included AAD score, stage, and splenectomy, the effect of AAD score and splenectomy did not change substantially compared to the univariate results. AAD score remained statistically significant (P = .0001), and splenectomy was of borderline significance (P = .09). Of the 18 solid tumor SMNs, 15 developed within the field of radiation, and one other developed in tissue irradiated 34 years earlier for hemangioma. This study of a large and unselected group of children with Hodgkin's disease who received a variety of therapies demonstrates that children are as likely as adults to develop acute leukemia after alkylating agents and solid tumors in the field of radiation therapy. SN - 0098-1532 UR - https://www.unboundmedicine.com/medline/citation/2586362/Second_malignant_neoplasms_following_childhood_Hodgkin's_disease:_treatment_and_splenectomy_as_risk_factors_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0098-1532&date=1989&volume=17&issue=6&spage=477 DB - PRIME DP - Unbound Medicine ER -