Hodgkin lymphoma: Use of modern combined modality therapy and its effect on the risk of second malignancies: The M. D. Anderson Experience over five decades.

Abstract

e18529 Background: The treatment of Hodgkin’s Lymphoma has radically changed over the past five decades. The change involved the type and number of cycles of chemotherapy; as well as the dose, fields, and techniques of radiation therapy. We here report on the change of incidence of second malignancies with the use of modern therapy. Methods: The medical record of 1671 patients diagnosed with Hodgkin’s lymphoma between June 1956 and June 2009 was reviewed. The subjects of this study are 949 patients with available follow-up information. Using logistic regression analysis we have looked at the correlation between the following factors and the risk for second malignancy: Age at diagnosis (<30, 30-50, and >50 years), Gender, stage at diagnosis (early favorable, early unfavorable, and advanced), type of chemotherapy (MOPP containing versus none), type of field of radiation used (involved fields, mantle, or extended), The use of three dimensional radiation modality, era of diagnosis by decades (<1995 versus > 1995), and relapse. Results: In univariate analysis The incidence of developing second malignancy was significantly associated with younger age at diagnosis (<30 years) (p=0.0001), the use of MOPP containing chemotherapy (p=0.004), the use of non modern radiotherapy techniques (p=0.01), patients who relapsed (p=0.0001), patients who were treated before 1995 (p=0.0001). On multivariate analysis factors that kept their significance includes: the use of MOPP containing chemotherapy (p0.0001), the use of outdate non modern radiotherapy techniques (p=0.001), patients treated before 1995, patients younger than 30 years of age at diagnosis (p=0.0001), number of radiation courses for relapsed patients (p=0.0001), and radiation dose of > 36 Gy (0.041). Conclusions: Modern therapy (standard after 1995 at our institution) represented by the use of non-MOPP chemotherapy, and modern techniques and lower doses of radiation is associated with a significant decrease of the risk of second malignancy.