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Risk of solid subsequent malignant neoplasms after childhood Hodgkin lymphoma–identification of high-risk populations to guide surveillance : A report from the Late Effects Study Group

Holmqvist, Anna S. LU ; Chen, Yanjun ; Berano Teh, Jennifer ; Sun, Canlan ; Birch, Jillian M. ; van den Bos, Cor ; Diller, Lisa R. ; Dilley, Kimberley ; Ginsberg, Jill and Martin, Laura T. , et al. (2019) In Cancer 125(8). p.1373-1383
Abstract

Background: Survivors of Hodgkin lymphoma (HL) in childhood have an increased risk of subsequent malignant neoplasms (SMNs). Herein, the authors extended the follow-up of a previously reported Late Effects Study Group cohort and identified patients at highest risk for SMNs to create evidence for risk-based screening recommendations. Methods: The standardized incidence ratio was calculated using rates from the Surveillance, Epidemiology, and End Results program as a reference. The risk of SMN was estimated using proportional subdistribution hazards regression. The cohort included 1136 patients who were diagnosed with HL before age 17 years between 1955 and 1986. The median length of follow-up was 26.6 years. Results: In 162 patients, a... (More)

Background: Survivors of Hodgkin lymphoma (HL) in childhood have an increased risk of subsequent malignant neoplasms (SMNs). Herein, the authors extended the follow-up of a previously reported Late Effects Study Group cohort and identified patients at highest risk for SMNs to create evidence for risk-based screening recommendations. Methods: The standardized incidence ratio was calculated using rates from the Surveillance, Epidemiology, and End Results program as a reference. The risk of SMN was estimated using proportional subdistribution hazards regression. The cohort included 1136 patients who were diagnosed with HL before age 17 years between 1955 and 1986. The median length of follow-up was 26.6 years. Results: In 162 patients, a total of 196 solid SMNs (sSMNs) were identified. Compared with the general population, the cohort was found to be at a 14-fold increased risk of developing an sSMN (95% confidence interval, 12.0-fold to 16.3-fold). The cumulative incidence of any sSMN was 26.4% at 40 years after a diagnosis of HL. Risk factors for breast cancer among females were an HL diagnosis between ages 10 years and 16 years and receipt of chest radiotherapy. Males treated with chest radiotherapy at age <10 years were found to be at highest risk of developing lung cancer. Survivors of HL who were treated with abdominal/pelvic radiotherapy and high-dose alkylating agents were found to be at highest risk of developing colorectal cancer and females exposed to neck radiotherapy at age <10 years were at highest risk of thyroid cancer. By age 50 years, the cumulative incidence of breast, lung, colorectal, and thyroid cancer was 45.3%, 4.2%, 9.5%, and 17.3%, respectively, among those at highest risk. Conclusions: Survivors of childhood HL remain at an increased risk of developing sSMNs. In the current study, subgroups of survivors of HL at highest risk of specific sSMNs were identified, and evidence for screening provided.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
childhood, Hodgkin lymphoma, long-term follow-up, screening recommendations, subsequent malignant neoplasm (SMN)
in
Cancer
volume
125
issue
8
pages
1373 - 1383
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:85058562015
  • pmid:30556153
ISSN
0008-543X
DOI
10.1002/cncr.31807
language
English
LU publication?
yes
id
153d9d0c-e760-40c2-a473-df4fd4645eca
date added to LUP
2019-01-14 15:09:04
date last changed
2024-04-01 19:25:32
@article{153d9d0c-e760-40c2-a473-df4fd4645eca,
  abstract     = {{<p>Background: Survivors of Hodgkin lymphoma (HL) in childhood have an increased risk of subsequent malignant neoplasms (SMNs). Herein, the authors extended the follow-up of a previously reported Late Effects Study Group cohort and identified patients at highest risk for SMNs to create evidence for risk-based screening recommendations. Methods: The standardized incidence ratio was calculated using rates from the Surveillance, Epidemiology, and End Results program as a reference. The risk of SMN was estimated using proportional subdistribution hazards regression. The cohort included 1136 patients who were diagnosed with HL before age 17 years between 1955 and 1986. The median length of follow-up was 26.6 years. Results: In 162 patients, a total of 196 solid SMNs (sSMNs) were identified. Compared with the general population, the cohort was found to be at a 14-fold increased risk of developing an sSMN (95% confidence interval, 12.0-fold to 16.3-fold). The cumulative incidence of any sSMN was 26.4% at 40 years after a diagnosis of HL. Risk factors for breast cancer among females were an HL diagnosis between ages 10 years and 16 years and receipt of chest radiotherapy. Males treated with chest radiotherapy at age &lt;10 years were found to be at highest risk of developing lung cancer. Survivors of HL who were treated with abdominal/pelvic radiotherapy and high-dose alkylating agents were found to be at highest risk of developing colorectal cancer and females exposed to neck radiotherapy at age &lt;10 years were at highest risk of thyroid cancer. By age 50 years, the cumulative incidence of breast, lung, colorectal, and thyroid cancer was 45.3%, 4.2%, 9.5%, and 17.3%, respectively, among those at highest risk. Conclusions: Survivors of childhood HL remain at an increased risk of developing sSMNs. In the current study, subgroups of survivors of HL at highest risk of specific sSMNs were identified, and evidence for screening provided.</p>}},
  author       = {{Holmqvist, Anna S. and Chen, Yanjun and Berano Teh, Jennifer and Sun, Canlan and Birch, Jillian M. and van den Bos, Cor and Diller, Lisa R. and Dilley, Kimberley and Ginsberg, Jill and Martin, Laura T. and Nagarajan, Rajaram and Nathan, Paul C. and Neglia, Joseph P. and Terenziani, Monica and Tishler, David and Meadows, Anna T. and Robison, Leslie L. and Oberlin, Odile and Bhatia, Smita}},
  issn         = {{0008-543X}},
  keywords     = {{childhood; Hodgkin lymphoma; long-term follow-up; screening recommendations; subsequent malignant neoplasm (SMN)}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{1373--1383}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Cancer}},
  title        = {{Risk of solid subsequent malignant neoplasms after childhood Hodgkin lymphoma–identification of high-risk populations to guide surveillance : A report from the Late Effects Study Group}},
  url          = {{http://dx.doi.org/10.1002/cncr.31807}},
  doi          = {{10.1002/cncr.31807}},
  volume       = {{125}},
  year         = {{2019}},
}