64 O - Second malignant neoplasms after hodgkin's disease (HD): an analysis of 1531 patients (PTS) treated in florence (1960–1991)

Purpose To define the risk of having a second malignant neoplasm (ST) in different subsets of HD patients, therefore possibly identifying clinico-therapeutic factors linked with an increased second tumor probability. Methods and materials Cumulative probability of having a ST has been calculated for the different clinical and therapeutic subgroups of a population of 1531 patients consecutively treated (1960–1991) for HD at the Florence Radiotherapy and Hematology Departments. Clinical stages (CS) at diagnosis were distributed as follows: CS I, 13%, CS II, 48%, CS III 30%. CS IV 9%, Initial treatment consisted of radiation alone (52%), combined modality treatment (21%), chemotherapy alone (27%). Incidence data in the different clinico-therapeutic subgroups of this series have been compared with multivariate analysis (Cox model). A comparison has been also made with the general population, deriving observed/expected ratios for the different tumor types. For selected tumor types, a “nested” case-control study is ongoing. Results An increased ST risk has been observed in patients older at HD diagnosis. The same trend was observed for second solid tumors (SST). However, the incidence of ST rises strikingly after very long follow up intervals, so that it is desirable to follow up indefinitely the cohorts of pts younger at HD diagnosis. Acute leukemia was more frequent in patients initially given chemotherapy, alone or associated with radiotherapy, while the relationships between SST occurrence and the treatment given are less evident.