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Prepublished online as a Blood First Edition Paper on June 7, 2002; DOI 10.1182/blood-2002-02-0634. This Article Full Text Full Text (PDF) All Versions of this Article: 2002-02-0634v1 100/6/1989    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Ng, A. K. Articles by Mauch, P. M. Search for Related Content PubMed PubMed Citation Articles by Ng, A. K. Articles by Mauch, P. M. Related Collections Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 September 2002, Vol. 100, No. 6, pp. 1989-1996 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors Andrea K. Ng, M. V. Patricia Bernardo, Edie Weller, Kendall Backstrand, Barbara Silver, Karen C. Marcus, Nancy J. Tarbell, Mary Ann Stevenson, Jonathan W. Friedberg, and Peter M. Mauch From the Department of Radiation Oncology and the Department of Medicine, Brigham and Women's Hospital; Children's Hospital; Beth Israel Deaconess Medical Center; Massachusetts General Hospital; Department of Biostatistical Sciences and Department of Adult Oncology, Dana-Farber Cancer Institute; Harvard Medical School; Boston, MA. The excess risk of second malignancy after Hodgkin disease is an increasing problem. In light of the long-term data, guidelines for follow-up of survivors of Hodgkin disease need to be redefined. In this study we attempt to analyze the long-term risks and temporal trends, identify patient- and treatment-related risk factors, and determine the prognosis of patients who develop a second malignancy after radiation treatment with or without chemotherapy for Hodgkin disease. Among 1319 patients with clinical stage I-IV Hodgkin disease, 181 second malignancies and 18 third malignancies were observed. With a median follow-up of 12 years, the relative risk (RR) and absolute excess risk of second malignancy were 4.6 and 89.3/10 000 person-years. The RR was significantly higher with combined chemotherapy and radiation therapy (6.1) than with radiation therapy alone (4.0, P = .015). The risk increased with increasing radiation field size (P = .03) in patients who received combined modality therapy, and with time after Hodgkin disease. After 15 and 20 years, there was a 2.3% and 4.0% excess risk of second malignancy per person per year. The 5-year survival after development of a second malignancy was 38.1%, with the worst prognosis seen after acute leukemia and lung cancer. The excess risk of second malignancy after Hodgkin disease continues to be increased after 15 to 20 years, and there does not appear to be a plateau. Our analysis suggests that the risk may be reduced with smaller radiation fields, as are used in current trials of abbreviated chemotherapy and limited-field radiation therapy. © 2002 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: E. C. Bluhm, C. Ronckers, R. J. Hayashi, J. P. Neglia, A. C. Mertens, M. Stovall, A. T. 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