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The risk of non-Hodgkin's lymphoma after Hodgkin's disease, with special reference to splenic treatment. 1998

R M Enrici, and A P Anselmo, and V Iacari, and M F Osti, and M Santoro, and V Tombolini, and F Mandelli, and C Biagini
Department of Radiation Oncology, Policlinico Umberto I, La Sapienza University of Rome, Italy.

OBJECTIVE One of the consequences of the enormous improvement in survival rates of patients treated for Hodgkin's disease (HD) is the emergence in the long term of treatment-related complications, particularly secondary cancers. This study was undertaken to observe the occurrence of non-Hodgkin's lymphoma (NHL) in patients treated for HD and to identify the etiological role of various risk factors, especially spleen irradiation, in the pathogenesis of this illness. METHODS From 1972 to 1996, the Department of Radiation Oncology and the Hematology Section of "La Sapienza" University of Rome observed and analyzed the occurrence of NHL in 1,391 patients treated for HD. The average follow-up period was 84 months. For a more accurate calculation of the risk of the occurrence of NHL, the patients were first divided into 3 groups according to their initial treatment and also according to the total treatment they had received. Then, in order to establish the possible connection between NHL and splenic treatment the patients were also divided into 3 subgroups according to whether they had undergone splenectomy, splenic irradiation or neither of these. Two different methods of statistical analysis were used: (a) the cumulative risk (confidence interval) was evaluated in relation to treatment (initial and at the time of salvage) and (b) the Cox model was applied to identify the variables which play a role in the appearance of NHL. The cumulative risk of developing NHL was assessed using the Kaplan and Meier method. A multivariate analysis was performed using the Cox Proportional Hazard Model. RESULTS A total of 20 cases of NHL were observed, appearing between 17 and 206 months after initial treatment. The cumulative risk was 0.8%, 1.8%, 2.6% and 3.5% at 5, 10, 15 and 20 years respectively. According to the multivariate analysis, significant risk factors were splenic irradiation and age (> 40 years). Splenic irradiation (vs no splenectomy/no splenic irradiation) showed a relative risk of 5.69, p = 0.0280, while age over 40 showed a relative risk of 3.05, p = 0.0152. CONCLUSIONS From the results of this study, if appears that there is a possibility that splenic irradiation and age over 40 increase the risk of NHL in HD patients. Further studies are needed to investigate in greater depth the role of spleen irradiation in the occurrence of this illness.

UI MeSH Term Description Entries
D008228 Lymphoma, Non-Hodgkin Any of a group of malignant tumors of lymphoid tissue that differ from HODGKIN DISEASE, being more heterogeneous with respect to malignant cell lineage, clinical course, prognosis, and therapy. The only common feature among these tumors is the absence of giant REED-STERNBERG CELLS, a characteristic of Hodgkin's disease. Non-Hodgkin Lymphoma,Diffuse Mixed Small and Large Cell Lymphoma,Diffuse Mixed-Cell Lymphoma,Diffuse Small Cleaved-Cell Lymphoma,Diffuse Undifferentiated Lymphoma,Lymphatic Sarcoma,Lymphoma, Atypical Diffuse Small Lymphoid,Lymphoma, Diffuse,Lymphoma, Diffuse, Mixed Lymphocytic-Histiocytic,Lymphoma, High-Grade,Lymphoma, Intermediate-Grade,Lymphoma, Low-Grade,Lymphoma, Mixed,Lymphoma, Mixed Cell, Diffuse,Lymphoma, Mixed Lymphocytic-Histiocytic,Lymphoma, Mixed Small and Large Cell, Diffuse,Lymphoma, Mixed-Cell,Lymphoma, Mixed-Cell, Diffuse,Lymphoma, Non-Hodgkin's,Lymphoma, Non-Hodgkin, Familial,Lymphoma, Non-Hodgkins,Lymphoma, Nonhodgkin's,Lymphoma, Nonhodgkins,Lymphoma, Pleomorphic,Lymphoma, Small Cleaved Cell, Diffuse,Lymphoma, Small Cleaved-Cell, Diffuse,Lymphoma, Small Non-Cleaved-Cell,Lymphoma, Small Noncleaved-Cell,Lymphoma, Small and Large Cleaved-Cell, Diffuse,Lymphoma, Undifferentiated,Lymphoma, Undifferentiated, Diffuse,Lymphosarcoma,Mixed Small and Large Cell Lymphoma, Diffuse,Mixed-Cell Lymphoma,Mixed-Cell Lymphoma, Diffuse,Non-Hodgkin's Lymphoma,Reticulosarcoma,Reticulum Cell Sarcoma,Reticulum-Cell Sarcoma,Sarcoma, Lymphatic,Sarcoma, Reticulum-Cell,Small Cleaved-Cell Lymphoma, Diffuse,Small Non-Cleaved-Cell Lymphoma,Small Noncleaved-Cell Lymphoma,Undifferentiated Lymphoma,Diffuse Lymphoma,Diffuse Lymphomas,Diffuse Mixed Cell Lymphoma,Diffuse Mixed-Cell Lymphomas,Diffuse Small Cleaved Cell Lymphoma,Diffuse Undifferentiated Lymphomas,High-Grade Lymphoma,High-Grade Lymphomas,Intermediate-Grade Lymphoma,Intermediate-Grade Lymphomas,Low-Grade Lymphoma,Low-Grade Lymphomas,Lymphatic Sarcomas,Lymphocytic-Histiocytic Lymphoma, Mixed,Lymphocytic-Histiocytic Lymphomas, Mixed,Lymphoma, Diffuse Mixed-Cell,Lymphoma, Diffuse Undifferentiated,Lymphoma, High Grade,Lymphoma, Intermediate Grade,Lymphoma, Low Grade,Lymphoma, Mixed Cell,Lymphoma, Mixed Lymphocytic Histiocytic,Lymphoma, Non Hodgkin,Lymphoma, Non Hodgkin's,Lymphoma, Non Hodgkins,Lymphoma, Nonhodgkin,Lymphoma, Small Non Cleaved Cell,Lymphoma, Small Noncleaved Cell,Lymphosarcomas,Mixed Cell Lymphoma,Mixed Cell Lymphoma, Diffuse,Mixed Lymphocytic-Histiocytic Lymphoma,Mixed Lymphocytic-Histiocytic Lymphomas,Mixed Lymphoma,Mixed Lymphomas,Mixed-Cell Lymphomas,Non Hodgkin Lymphoma,Non Hodgkin's Lymphoma,Non-Cleaved-Cell Lymphoma, Small,Non-Hodgkins Lymphoma,Noncleaved-Cell Lymphoma, Small,Nonhodgkin's Lymphoma,Nonhodgkins Lymphoma,Pleomorphic Lymphoma,Pleomorphic Lymphomas,Reticulosarcomas,Reticulum Cell Sarcomas,Reticulum-Cell Sarcomas,Sarcoma, Reticulum Cell,Small Cleaved Cell Lymphoma, Diffuse,Small Non Cleaved Cell Lymphoma,Small Non-Cleaved-Cell Lymphomas,Small Noncleaved Cell Lymphoma,Small Noncleaved-Cell Lymphomas,Undifferentiated Lymphoma, Diffuse,Undifferentiated Lymphomas
D008297 Male Males
D009381 Neoplasms, Radiation-Induced Tumors, cancer or other neoplasms produced by exposure to ionizing or non-ionizing radiation. Radiation-Induced Cancer,Cancer, Radiation-Induced,Radiation-Induced Neoplasms,Cancer, Radiation Induced,Cancers, Radiation-Induced,Neoplasm, Radiation-Induced,Neoplasms, Radiation Induced,Radiation Induced Cancer,Radiation Induced Neoplasms,Radiation-Induced Cancers,Radiation-Induced Neoplasm
D005260 Female Females
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006689 Hodgkin Disease A malignant disease characterized by progressive enlargement of the lymph nodes, spleen, and general lymphoid tissue. In the classical variant, giant usually multinucleate Hodgkin's and REED-STERNBERG CELLS are present; in the nodular lymphocyte predominant variant, lymphocytic and histiocytic cells are seen. Granuloma, Hodgkin,Granuloma, Malignant,Hodgkin Lymphoma,Lymphogranuloma, Malignant,Granuloma, Hodgkin's,Granuloma, Hodgkins,Hodgkin Lymphoma, Adult,Hodgkin's Disease,Hodgkin's Lymphoma,Hodgkins Disease,Lymphocyte Depletion Hodgkin's Lymphoma,Lymphocyte-Rich Classical Hodgkin's Lymphoma,Mixed Cellularity Hodgkin's Lymphoma,Nodular Lymphocyte-Predominant Hodgkin's Lymphoma,Nodular Sclerosing Hodgkin's Lymphoma,Adult Hodgkin Lymphoma,Disease, Hodgkin,Disease, Hodgkin's,Disease, Hodgkins,Hodgkin Granuloma,Hodgkin's Granuloma,Hodgkins Granuloma,Hodgkins Lymphoma,Lymphocyte Rich Classical Hodgkin's Lymphoma,Lymphogranulomas, Malignant,Lymphoma, Hodgkin,Lymphoma, Hodgkin's,Malignant Granuloma,Malignant Granulomas,Malignant Lymphogranuloma,Malignant Lymphogranulomas,Nodular Lymphocyte Predominant Hodgkin's Lymphoma
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D013154 Spleen An encapsulated lymphatic organ through which venous blood filters.

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