High Long-Term Risk of Solid Cancers in Survivors of Childhood Hodgkin Lymphoma
A new study may bolster existing evidence that survivors of childhood Hodgkin lymphoma face an elevated risk of developing various types of solid tumors many years later. The study showed that certain subgroups of patients have an especially high risk. Published by Holmqvist et al in the journal Cancer, the findings may help refine guidelines for cancer screening in Hodgkin lymphoma survivors.
Study Background
It is known that survivors of pediatric Hodgkin lymphoma have an increased risk of developing additional forms of cancer, including solid cancers, but the magnitude of this risk over the long term has been unknown. To investigate, senior study author Smita Bhatia, MD, MPH, of the University of Alabama at Birmingham, and her colleagues analyzed information on 1,136 patients who were diagnosed with Hodgkin lymphoma before age 17 years between 1955 and 1986. Over a median length of follow-up of 26.6 years, 162 individuals developed solid cancers.
The researchers determined that the survivors had a 14-fold increased risk of developing cancer compared with the general population (95% confidence interval [CI] = 12.0-fold to 16.3-fold). They also noted that the cumulative incidence of any solid cancer was 26.4% at 40 years after a Hodgkin lymphoma diagnosis.
High-Risk Subgroups
Risk factors for breast cancer among females were Hodgkin lymphoma diagnosis between 10 and 16 years of age and chest radiation. Males treated with chest radiation before 10 years of age were at highest risk for lung cancer. Hodgkin lymphoma survivors treated with abdominal/pelvic radiation and high-dose alkylating agents were at highest risk for colorectal cancer, and females exposed to neck radiation before 10 years of age were at highest risk for 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.
“This large multi-institutional, international cohort of childhood Hodgkin lymphoma [survivors] allowed us to determine the risk of new solid cancers such as breast cancer, colorectal cancer, and thyroid cancer,” said Dr. Bhatia. “More importantly, we were able to use host and clinical characteristics to identify subgroups of Hodgkin lymphoma survivors who were particularly vulnerable to developing these new cancers.”
She noted that these findings could be useful for developing screening strategies for individual survivors.
Disclosure: The study authors’ full disclosures can be found at onlinelibrary.wiley.com.
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