Abstract
To determine the incidence and possible causes of second primary malignancies after treatment for Hodgkin's and Non-Hodgkin's lymphoma (HL and NHL). A cohort of 3764 consecutive patients diagnosed with HL or NHL between January 1970 and July 2001 was identified using the Sheffield Lymphoma Group database. A search was undertaken for all patients diagnosed with a subsequent primary malignancy. Two matched controls were identified for each case. Odds ratios were calculated to detect and quantify any risk factors in the cases compared to their matched controls. Mean follow-up for the cohort was 5.2 years. A total of 68 patients who developed second cancers at least 6 months after their primary diagnosis were identified, giving a crude incidence of 1.89% overall: 3.21% among the patients treated for HL, 1.32% in those treated for NHL. Most common were bronchial, breast, colorectal and haematological malignancies. High stage at diagnosis almost reached statistical significance in the analysis of just the NHL patients (odds ratio=3.48; P=0.068) after adjustment for other factors. Treatment modality was not statistically significant in any analysis. High stage at diagnosis of NHL may be a risk factor for developing a second primary cancer.
Highlights
An association between HL and other tumours was first documented in 1957 (Moertal and Hagendorn, 1957) when a combined review and case series of 120 patients was published
The major risk was thought to be from second acute leukaemias (Canellos et al, 1975; Pederson-Bjergaard and Larsen, 1982; Valagussa et al, 1986) and associations were quickly demonstrated with certain chemotherapy regimens such as MOPP (Valagussa et al, 1986; Kaldor et al, 1990; Tura et al, 1993)
3764 consecutive patients diagnosed with HL or NHL between the January 1970 and 28 July 2001 were identified using the Sheffield Lymphoma Group database
Summary
A Okines, CS Thomson, CR Radstone, JM Horsman and BW Hancock*,1 1YCR Academic Unit of Clinical Oncology, Weston Park Hospital, Whitham Road, Sheff ield S10 2SJ, UK; 2Trent Cancer Registry, 5 Old Fulwood Road, Sheff ield S10 3TG, UK. High stage at diagnosis of NHL may be a risk factor for developing a second primary cancer. Much controversy exists as to the major risk factors for developing second solid cancers, with many investigators finding an increased risk in all treatment groups (Tucker et al, 1988; Boivin et al, 1995; Dores et al, 2002). A study published in 1990 (Lavey et al, 1990) described an incidence of second solid tumours similar to that expected in the general population, with significant differences only present for salivary gland tumours (both overall and in patients treated with chemotherapy alone) and malignant melanomas (overall). Vital to define the risk factors for each type of malignancy, so that either these can be modified or patients at particular risk can be closely monitored
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