Decreasing Risk of Leukemia with Prolonged Follow-up after Chemotherapy and Radiotherapy for Hodgkin's Disease

Acute nonlymphocytic leukemia is a recognized complication of combined chemotherapy and radiation treatment of patients with Hodgkin's disease. Previous studies have suggested that the risk of leukemia in these patients increases with time after treatment. We analyzed the occurrence of second neoplasms among 192 patients with Hodgkin's disease who were followed for a median of over 15 years. We originally planned to identify prospectively the morphologic changes in bone marrow that precede the development of acute leukemia. All 63 patients consenting to bone marrow aspiration had normal marrow morphology, and no case of acute leukemia occurred more than 11 years after treatment. Actuarial analysis revealed that the peak onset of leukemia-related complications was between three and nine years after first treatment. We conclude that there appears to be a period of increased risk in patients treated with chemotherapy and radiation, after which the risk of secondary leukemia decreases. Patients surviving for more than 11 years after treatment appear to be at no increased risk of acute leukemia. (N Engl J Med 1987; 316:710–4.) THE introduction of megavoltage radiation therapy and the MOPP regimen (mechlorethamine [Mustargen], vincristine [Oncovin], procarbazine, and prednisone) for Hodgkin's disease 1 , 2 has resulted in impressive long-term survival among patients in whom such tumors had previously been fatal. 3 Approximately 70 percent of all patients and 50 percent of patients with advanced disease can be cured by radiation therapy alone, radiation therapy plus combination chemotherapy, or in those with advanced disease, combination chemotherapy alone. This success has resulted in the survival of a large number of patients who formerly were destined to die in less than five years, and these survivors are available . . .