Risk of leukemia following treatment for Hodgkin lymphoma

The current study examined the risk of developing acute myeloid leukemia/myelodysplastic syndrome (tAML/MDS) following treatment for Hodgkin lymphoma. The study determined that there was an association between alkylating agent chemotherapy and the risk of tAML/MDS.

Treatments for Hodgkin lymphoma have been associated with multiple long-term risks. Both chemotherapy and radiation are known to increase the risk of second cancers and cardiovascular disease. Radiation has been associated with solid tumors (such as lung or breast cancer). Chemotherapy and large areas of radiation have been associated with leukemia. In particular, alkylating chemotherapy agents (such as mechlorethamine) are known to increase the risk of leukemia.

In tAML/MDS, the bone marrow produces abnormal white blood cells. Alkylating agents can increase the risk of this type of cancer. Radiation can also increase the risk. Treatment doses have been modified in recent years. Chemotherapy and radiation doses have decreased. It is not clear whether these modifications have affected the risk of tAML/MDS.

This study examined the risk of tAML/MDS in patients treated with different chemotherapy combinations. The study included information on 754 patients treated over a 29-year period. The patients were divided into three groups depending on the type of chemotherapies received.

Group S was treated mainly with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) or PAVe (procarbazine, mechlorethamine, and vinblastine).

Group C was treated with MOPP, PAVe, VBM (vinblastine, bleomycin, and methotrexate), or ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine).

Group G was treated with VbM (VBM with a reduced dose of bleomycin) or Stanford V (mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone). The total exposure to alkylating agents was lowest in Group G.

3.2% of all patients developed tAML/MDS. The rate was lowest in Group G (0.3%). 5.7% of patients in Group S and 5.2% of patients in Group C developed tAML/MDS. Only 1 patient treated with ABVD developed tAML/MDS.

This study concluded that higher doses of alkylating agents were associated with an increased risk of tAML/MDS. Lower doses were associated with a reduced rate of occurrence.