Risk of multiple primary malignancies following treatment of Hodgkin lymphoma
Menée sur une cohorte de 3 122 patients atteints d'un lymphome hodgkinien diagnostiqué avant l'âge de 51 ans et traité entre 1965 et 1995 (durée médiane de suivi : 22,6 ans), cette étude évalue le risque de cancers primitifs après traitement (958 cas)
We assessed risk, localization, and timing of third malignancies in Hodgkin lymphoma (HL) survivors. In a cohort of 3,122 5-year HL survivors, diagnosed before age 51 and treated between 1965-1995, we examined whether risk factors for second and third malignancies differ and whether the occurrence of a second malignancy affects the risk of a subsequent malignancy, using recurrent event analyses. After a median follow-up of 22.6 years, 832 patients developed a second malignancy and 126 patients a third one. The risk of a second malignancy was 4.7-fold (95% confidence interval (CI) 4.4-5.1) increased compared to risk in the general population; the standardized incidence ratio for a third malignancy after a second malignancy was 5.4 (95%CI 4.4-6.5). The 10-year cumulative incidence of any third malignancy was 17.1% among females and 9.2% among males (p=0.000). Compared to patients still free of a second malignancy, patients with a second malignancy had a higher risk to develop a subsequent malignancy. This risk depended on age, with hazard ratios of 2.2, 1.6 and 1.1 for patients aged <25, 25-34 and 35-50 years at HL treatment, respectively. In HL survivors who had a second malignancy, treating physicians should be aware of the increased risk of subsequent malignancies.
Blood 2014