Late effects of Hodgkin's lymphoma salvage therapy "significant"

NEW YORK (Reuters Health) - High-dose chemoradiotherapy and autologous stem-cell rescue, the standard treatment for patients with relapsed/refractory Hodgkin's lymphoma, is associated with significant late morbidity and mortality, according to a study posted online September 22 ahead of print by the Journal of Clinical Oncology.

Dr. Karyn A. Goodman from Memorial Sloan-Kettering Cancer Center, New York, and colleagues evaluated 153 of 218 patients treated by high-dose chemoradiotherapy and autologous stem-cell rescue at Sloan-Kettering from 1985 to 1998 who survived for at least 2 years after treatment.

During a median follow up of 11.5 years after rescue therapy, a total of 53 patients died; 33 from Hodgkin's lymphoma and 20 from other causes.

Thirteen deaths were caused by second malignancy, with a median time from therapy to second malignancy of 9 years (range, 3 to 18 years). The risk ratio of second malignancy was 6.5 when compared to the general population, but 2.4 when compared with patients with Hodgkin's lymphoma, the researchers report.

The global quality of life of the patients was comparable with that of the general population. However, late treatment-related morbidity was "significant, with cardiac, pulmonary, and infertility issues," as well as reduced functioning.

"This study confirms that patients with relapsed or refractory Hodgkin's lymphoma who undergo salvage high-dose chemoradiotherapy and stem-cell rescue are at highest risk of death from recurrent Hodgkin's lymphoma," the researchers note.

Late effects of therapy are also significant among the increasing number of long-term survivors, "with a 15-year cumulative mortality from second malignancy of 11%," they also point out.

It's important to note, Dr. Goodman and colleagues say, that during the past 4 decades, treatment modifications have reduced late effects from conventional therapies. "With the current combined-modality therapy using moderate doses of IFRT and fewer cycles of risk-adapted chemotherapy, cardiac complications and development of second malignancies should diminish."

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