Second malignancies in patients with Hodgkin’s Lymphoma: Half a century of experience
Purpose: Therapeutic improvements for Hodgkin’s Lymphoma (HL) has resulted in excellent survival outcomes. Thus, patients are increasing susceptible to developing secondary malignancy (SM) a feared iatrogenic complication. Materials & Methods: We evaluated the SM risk in a cohort of patients...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-07-01
|
| Series: | Clinical and Translational Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630822000349 |
| _version_ | 1828318509777551360 |
|---|---|
| author | Bouthaina Shbib Dabaja David Boyce-Fappiano Wenli Dong Ethan Damron Penny Fang Jill Gunther Maria A. Rodriguez Paolo Strati Raphael Steiner Ranjit Nair Hun Lee Zeinab Abou Yehia Ferial Shihadeh Chelsea Pinnix Andrea K. Ng |
| author_facet | Bouthaina Shbib Dabaja David Boyce-Fappiano Wenli Dong Ethan Damron Penny Fang Jill Gunther Maria A. Rodriguez Paolo Strati Raphael Steiner Ranjit Nair Hun Lee Zeinab Abou Yehia Ferial Shihadeh Chelsea Pinnix Andrea K. Ng |
| author_sort | Bouthaina Shbib Dabaja |
| collection | DOAJ |
| description | Purpose: Therapeutic improvements for Hodgkin’s Lymphoma (HL) has resulted in excellent survival outcomes. Thus, patients are increasing susceptible to developing secondary malignancy (SM) a feared iatrogenic complication. Materials & Methods: We evaluated the SM risk in a cohort of patients with HL treated over a 50-year period. In total, 1653 patients were treated for HL from 1956 to 2009 at a tertiary-cancer-center. A cumulative incidence function was used to quantify SM risk and the Fine and Gray competing risk model was used to identify disease and treatment related correlates. Results: Two-hundred-ninety patients (19%) developed SMs. Paradoxically, SM risk was higher in the modern era with 20-year cumulative incidence rates of 11.1%, 11.9%, 17% and 21.8%, for patients treated <1970, 1971–1986, 1986–1995 and 1996–2009, respectively. We hypothesized that the disproportionately high rate of early deaths in the early era may skew the assessment of SM risks, a much-delayed event. When the analysis was restricted to patients with early-stage favorable HL treated >1980, we found a reversal of the trend, especially on the risk of solid tumor, with a hazard ratio of 0.57 (p = 0.0651) in patients treated after 1996. Conclusion: Our findings highlight the limitations of comparing the risk of a late event between groups with disparate rates of early deaths, despite the use of a competing risk model. When partially corrected for, patients treated in the more recent time period experienced a lower solid tumor risk. |
| first_indexed | 2024-04-13T17:43:28Z |
| format | Article |
| id | doaj.art-a4338188d5c948ccbd8d7d5d7a1b4869 |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-04-13T17:43:28Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-a4338188d5c948ccbd8d7d5d7a1b48692022-12-22T02:37:06ZengElsevierClinical and Translational Radiation Oncology2405-63082022-07-01356469Second malignancies in patients with Hodgkin’s Lymphoma: Half a century of experienceBouthaina Shbib Dabaja0David Boyce-Fappiano1Wenli Dong2Ethan Damron3Penny Fang4Jill Gunther5Maria A. Rodriguez6Paolo Strati7Raphael Steiner8Ranjit Nair9Hun Lee10Zeinab Abou Yehia11Ferial Shihadeh12Chelsea Pinnix13Andrea K. Ng14Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Corresponding author at: Department of Radiation Oncology, Division of Radiation Oncology Incident Commander, University of Texas MD Anderson Cancer Center, Director of Research of the International Lymphoma Radiation Oncology Group (ILROG), 1515 Holcombe Blvd., Houston, TX 77030, USA.Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartment of Radiation Oncology, Rutgers Robertwood Johnson Medical Center, Houston, TX, USADepartments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USADepartment of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Houston, TX, USAPurpose: Therapeutic improvements for Hodgkin’s Lymphoma (HL) has resulted in excellent survival outcomes. Thus, patients are increasing susceptible to developing secondary malignancy (SM) a feared iatrogenic complication. Materials & Methods: We evaluated the SM risk in a cohort of patients with HL treated over a 50-year period. In total, 1653 patients were treated for HL from 1956 to 2009 at a tertiary-cancer-center. A cumulative incidence function was used to quantify SM risk and the Fine and Gray competing risk model was used to identify disease and treatment related correlates. Results: Two-hundred-ninety patients (19%) developed SMs. Paradoxically, SM risk was higher in the modern era with 20-year cumulative incidence rates of 11.1%, 11.9%, 17% and 21.8%, for patients treated <1970, 1971–1986, 1986–1995 and 1996–2009, respectively. We hypothesized that the disproportionately high rate of early deaths in the early era may skew the assessment of SM risks, a much-delayed event. When the analysis was restricted to patients with early-stage favorable HL treated >1980, we found a reversal of the trend, especially on the risk of solid tumor, with a hazard ratio of 0.57 (p = 0.0651) in patients treated after 1996. Conclusion: Our findings highlight the limitations of comparing the risk of a late event between groups with disparate rates of early deaths, despite the use of a competing risk model. When partially corrected for, patients treated in the more recent time period experienced a lower solid tumor risk.http://www.sciencedirect.com/science/article/pii/S2405630822000349Hodgkin's LymphomaRadiationSecondary MalignancyToxicity |
| spellingShingle | Bouthaina Shbib Dabaja David Boyce-Fappiano Wenli Dong Ethan Damron Penny Fang Jill Gunther Maria A. Rodriguez Paolo Strati Raphael Steiner Ranjit Nair Hun Lee Zeinab Abou Yehia Ferial Shihadeh Chelsea Pinnix Andrea K. Ng Second malignancies in patients with Hodgkin’s Lymphoma: Half a century of experience Clinical and Translational Radiation Oncology Hodgkin's Lymphoma Radiation Secondary Malignancy Toxicity |
| title | Second malignancies in patients with Hodgkin’s Lymphoma: Half a century of experience |
| title_full | Second malignancies in patients with Hodgkin’s Lymphoma: Half a century of experience |
| title_fullStr | Second malignancies in patients with Hodgkin’s Lymphoma: Half a century of experience |
| title_full_unstemmed | Second malignancies in patients with Hodgkin’s Lymphoma: Half a century of experience |
| title_short | Second malignancies in patients with Hodgkin’s Lymphoma: Half a century of experience |
| title_sort | second malignancies in patients with hodgkin s lymphoma half a century of experience |
| topic | Hodgkin's Lymphoma Radiation Secondary Malignancy Toxicity |
| url | http://www.sciencedirect.com/science/article/pii/S2405630822000349 |
| work_keys_str_mv | AT bouthainashbibdabaja secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT davidboycefappiano secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT wenlidong secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT ethandamron secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT pennyfang secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT jillgunther secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT mariaarodriguez secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT paolostrati secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT raphaelsteiner secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT ranjitnair secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT hunlee secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT zeinababouyehia secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT ferialshihadeh secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT chelseapinnix secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience AT andreakng secondmalignanciesinpatientswithhodgkinslymphomahalfacenturyofexperience |