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

Anna S. Holmqvist, Yanjun Chen, Jennifer Berano Teh, Canlan Sun, Jillian M. Birch, Cor van den Bos, Lisa R. Diller, Kimberley Dilley, Jill Ginsberg, Laura T. Martin, Rajaram Nagarajan, Paul C. Nathan, Joseph P. Neglia, Monica Terenziani, David Tishler, Anna T. Meadows, Leslie L. Robison, Odile Oberlin, Smita Bhatia

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 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.

Original languageEnglish
Pages (from-to)1373-1383
Number of pages11
JournalCancer
Volume125
Issue number8
DOIs
Publication statusPublished - Apr 15 2019

Fingerprint

Hodgkin Disease
Population
Neoplasms
Survivors
Radiotherapy
Thyroid Neoplasms
Colorectal Neoplasms
Lung Neoplasms
Incidence
Thorax
SEER Program
Breast Neoplasms
Alkylating Agents
Cohort Studies
Neck
Confidence Intervals

Keywords

  • childhood
  • Hodgkin lymphoma
  • long-term follow-up
  • screening recommendations
  • subsequent malignant neoplasm (SMN)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

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.; Chen, Yanjun; Berano Teh, Jennifer; Sun, Canlan; Birch, Jillian M.; van den Bos, Cor; Diller, Lisa R.; Dilley, Kimberley; Ginsberg, Jill; Martin, Laura T.; Nagarajan, Rajaram; Nathan, Paul C.; Neglia, Joseph P.; Terenziani, Monica; Tishler, David; Meadows, Anna T.; Robison, Leslie L.; Oberlin, Odile; Bhatia, Smita.

In: Cancer, Vol. 125, No. 8, 15.04.2019, p. 1373-1383.

Research output: Contribution to journalArticle

Holmqvist, AS, Chen, Y, Berano Teh, J, Sun, C, Birch, JM, van den Bos, C, Diller, LR, Dilley, K, Ginsberg, J, Martin, LT, Nagarajan, R, Nathan, PC, Neglia, JP, Terenziani, M, Tishler, D, Meadows, AT, Robison, LL, Oberlin, O & Bhatia, S 2019, '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', Cancer, vol. 125, no. 8, pp. 1373-1383. https://doi.org/10.1002/cncr.31807
Holmqvist, Anna S. ; Chen, Yanjun ; Berano Teh, Jennifer ; Sun, Canlan ; Birch, Jillian M. ; van den Bos, Cor ; Diller, Lisa R. ; Dilley, Kimberley ; Ginsberg, Jill ; Martin, Laura T. ; Nagarajan, Rajaram ; Nathan, Paul C. ; Neglia, Joseph P. ; Terenziani, Monica ; Tishler, David ; Meadows, Anna T. ; Robison, Leslie L. ; Oberlin, Odile ; Bhatia, Smita. / 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. In: Cancer. 2019 ; Vol. 125, No. 8. pp. 1373-1383.
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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 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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T1 - Risk of solid subsequent malignant neoplasms after childhood Hodgkin lymphoma—Identification of high-risk populations to guide surveillance

T2 - A report from the Late Effects Study Group

AU - Holmqvist, Anna S.

AU - Chen, Yanjun

AU - Berano Teh, Jennifer

AU - Sun, Canlan

AU - Birch, Jillian M.

AU - van den Bos, Cor

AU - Diller, Lisa R.

AU - Dilley, Kimberley

AU - Ginsberg, Jill

AU - Martin, Laura T.

AU - Nagarajan, Rajaram

AU - Nathan, Paul C.

AU - Neglia, Joseph P.

AU - Terenziani, Monica

AU - Tishler, David

AU - Meadows, Anna T.

AU - Robison, Leslie L.

AU - Oberlin, Odile

AU - Bhatia, Smita

PY - 2019/4/15

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N2 - 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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