Predictive factors to develop a second neoplasia in a Hodgkin disease cohort patients

Abstract

6707 Background: Hodgkin's lymphoma (HL) is a rare malignancy, incidence rate (IR): 2.4/105 inh/y, 85% can be cured. The importance of late effects of therapy have become more apparent. Purpose: to determine the IR of second malignancies (SM)in HL and to compare with cancer IR in general population during 1978–1998. Methods: a cohort of 295 patients diagnosed as having in the Hematology Department of Miguel Servet University Hospital was followed-up (population at risk: 533,946 inh). Data source: clinical reports and poblational based Cancer Registry. Variables: demographic data, date of HL diagnosis, histological subtype, stage, treatment schedule (chemotherapy, radiotherapy, combined), date SM diagnosis, subtype and location of cancer. Cohort was stratified according to age, gender and schedule of therapy. Other risk factors related to cancer were considered (smoke, toxic contacts, previous neoplasia). A bivariant study and we perform a lineal regression model and its coefficient have been done. Results: IR of HL in our population is 2.4 cases/105 inh/y (F:1.87; M:3.03); estimated cancer IR in our area: 255.2 SD 32.3 cases/105 inh/y (1978–1998). Mean age: 38.3 SD 26 y. M/F 67%/33%. Subtype: NE 71%, MC22%, LP 24; stage: IA 12.7%, IB 1.6%, IIA 27.9%, IIB 5%, IIIA 16.9%, IIIB 14.4% IVA 9.3% IVB 11.8%. Radiotherapy 16.1% (mantle 50%, inverted-Y 11.8 %, both: 1.6%;cobalt 59.3%, linear accelerator 4.2%; total dose 20–36 Gy), chemotherapy 39.8% (ABVD 14.4%, MOPP 15.5%, CMOPP 23.7%, CMOPP/ABVD 18.6%, ABVD/MOPP 15.2%), combined 44%. HL relapsed: 10.1%, mean time: 49 m. Developed a SM 15(12.7%), mean 102.3 m; range 9–285: 11 a non-hematological neoplasia: adenocarcinoma (colon, breast, lung, oropharynx, skin, cavum, parotida. thyroid) and 4 a hematological neoplasia (AML and NHL). The global risk of cancer in HL was 10.0 and 6.5 when only non hematological tumor were considered. No variable with predictive value was found in the model. Conclusions: The incidence of SM among long-time survivors of HL is higher than in normal population. In other essays the major risk has been observed in patients treated with radiotherapy either alone or combined with chemotherapy. No significant financial relationships to disclose.