Racial/Ethnic Disparities on the Risk of Second Malignant Neoplasm Among Hodgkin Lymphoma Survivors.

Han Xiao,Li Wang,Xinyu Yan,Qing Xiao,Duo Cai,Jianghua He,Jianxiang Chi,Qiao Zhou,Simin Liang,Lanxiang Liu

doi:10.3389/fonc.2021.790891

Abstract

BackgroundHodgkin lymphoma survivors are at risk for second malignant neoplasm (SMN). How race/ethnicity affects the risk remains unclear.MethodsThis retrospective cohort study included 22,415 patients diagnosed with primary Hodgkin lymphoma from January 1992 to December 2015 in 13 Surveillance, Epidemiology, and End Results-based registries and divided patients into four groups: non-Hispanic whites, non-Hispanic blacks, Hispanics, and Asian/others. Taking non-Hispanic whites as a reference, both the proportional subdistribution hazard (PSH) and the cause-specific hazard (CSH) methods were used to calculate the SMN hazard ratio for other racial/ethnic groups with and without considering the competing mortality risk.Results1,778 patients developed SMN with a median follow-up of 11.63 years. In the adjusted PSH model, Hispanic, Asian/others, and non-Hispanic black patients had 26% (PSH, 0.74; 95% CI, 0.63–0.87), 20% (PSH, 0.80; 95% CI, 0.64–1.01), and 12% (PSH, 0.88; 95% CI, 0.75–1.03) decreased overall SMN hazard, respectively. Moreover, the PSH method revealed the racial/ethnic difference in the SMN risk in the skin, the respiratory system, and the endocrine system. These hazards were slightly higher and different with the use of the CSH approach. In addition to the aforementioned overall SMN and subtypes, adjusted CSH analysis also revealed the racial/ethnic disparities in the risk of subsequent female breast cancer, digestive cancer, and non-Hodgkin lymphoma.ConclusionsThe subtype and SMN risk among Hodgkin lymphoma survivors varied by race/ethnicity. The use of CSH and PSH provides a dynamic view of racial/ethnic effects on SMN risk in Hodgkin lymphoma survivors.

Highlights

Hodgkin lymphoma is a group of lymphoid neoplasms in which cancerous Reed–Sternberg cells are mixed with heterogeneous inflammatory cells, accounting for approximately 10% of all lymphomas, 0.6% of all cancers, and 0.2% of all cancer mortalities [1,2,3]
Olszewski et al reported that black and Hispanic patients received radiotherapy less frequently than white patients [23]. Given this potential difference in clinical factors, second malignant neoplasms (SMNs) risk could differ by race/ethnicity, which has important clinical implications on the long-term follow-up of Hodgkin lymphoma survivors
To obtain a dynamic understanding of the racial/ethnic effects on SMN among Hodgkin lymphoma survivors, the proportional subdistribution hazard (PSH) and the cause-specific hazard (CSH) methods were used in the present study

Summary

Introduction

Hodgkin lymphoma is a group of lymphoid neoplasms in which cancerous Reed–Sternberg cells are mixed with heterogeneous inflammatory cells, accounting for approximately 10% of all lymphomas, 0.6% of all cancers, and 0.2% of all cancer mortalities [1,2,3]. Studies have demonstrated that Hodgkin lymphoma survivors have a higher risk of developing solid tumors and hematologic malignancies than the general population [6, 7]. These second malignant neoplasms (SMNs) significantly impact the long-term survival of Hodgkin lymphoma patients [8, 9]. Olszewski et al reported that black and Hispanic patients received radiotherapy less frequently than white patients [23] Given this potential difference in clinical factors, SMN risk could differ by race/ethnicity, which has important clinical implications on the long-term follow-up of Hodgkin lymphoma survivors.

Methods

Results

Conclusion