Real-World Studies
Long-Term Second Cancer Risks in Female Hodgkin Lymphoma Survivors Across Treatment Eras
Macklin-Doherty et alJournal of clinical oncology : official journal of the American Society of Clinical Oncology
In a population-based cohort study evaluating long-term outcomes in female survivors of Hodgkin lymphoma (HL), researchers analyzed subsequent primary malignancy (SPM) risks among 7,428 women diagnosed with HL before age 36 years in England and Wales between 1954 and 2010, with registry follow-up extending through 2018. Over a median follow-up period of 20.2 years, 1,200 women developed 1,467 invasive cancers, corresponding to a standardized incidence ratio (SIR) of 3.3 (95% CI, 3.1 to 3.5). The most frequently observed malignancies were breast, lung, and thyroid cancers.
Solid tumor risks were highest following radiotherapy and displayed a strong dose-dependent response. Treatment with alkylating agents combined with radiotherapy was associated with a lower risk of breast cancer but an increased risk of gastrointestinal malignancies.
When comparing treatment eras, solid cancer risks decreased by 25% from 1954–1989 to 2000–2010. This temporal reduction was attenuated and nonsignificant following adjustment for radiotherapy changes, whereas adjustment for chemotherapy regimens did not alter the trend. Conversely, incidence rates for subsequent hematologic malignancies showed no decline across treatment periods.
The cumulative incidence of SPMs reached 36% at 50 years post-diagnosis. The findings indicate that while modern improvements, dose reductions, and reduced utilization of radiotherapy have lowered solid SPM risks in recent cohorts, risks for malignancies such as breast and lung cancer remain elevated for decades, supporting the necessity of lifelong surveillance and targeted screening protocols for female HL survivors.
Key Takeaways
- Female Hodgkin lymphoma survivors experienced a 25% reduction in solid cancer risks between the 1954–1989 and 2000–2010 treatment eras, an improvement attenuated after adjusting for radiotherapy modifications, with no corresponding decline observed for hematologic malignancies.
- Across a median follow-up of 20.2 years, survivors exhibited an overall standardized incidence ratio of 3.3 (95% CI, 3.1 to 3.5) for invasive subsequent primary malignancies, reaching a cumulative incidence of 36% at 50 years.
- Alkylator therapy administered alongside radiotherapy was associated with decreased breast cancer risk but increased gastrointestinal cancer risk, while elevated risks for lung and breast cancers persisted past 50 years of follow-up.
Read the original sourceJournal of clinical oncology : official journal of the American Society of Clinical Oncology