LEUKEMIA FOLLOWING HODGKINS-DISEASE
LEUKEMIA FOLLOWING HODGKINS-DISEASE
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DOI：
10.1056/nejm199001043220102
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发表时间：
1990-01-04
影响因子：
158.5
通讯作者：
STOVALL, M
中科院分区：
文献类型：
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作者：
KALDOR, JM;DAY, NE;STOVALL, M
为了研究霍奇金病的不同治疗方法对白血病风险的影响，我们利用癌症登记处和医院的国际合作小组对163例霍奇金病治疗后的白血病患者进行了病例对照研究。对于每例白血病患者，选择三名匹配的对照组，他们接受过霍奇金病治疗，但没有发生白血病。与单独使用放射治疗相比，单独使用化疗治疗霍奇金病与白血病的相对风险为9.0（95%置信区间，4.1 - 20）相关。接受这两种治疗的患者的相对风险为7.7（95%置信区间为3.9至15）。经过超过6个周期的联合治疗，包括甲基苄肼和氮芥，白血病的风险比单独放疗高14倍。放疗与化疗联合使用并没有增加白血病的风险超过单独使用化疗产生的风险，但在单独接受放疗的患者中，白血病的风险呈剂量相关性增加。白血病风险的峰值出现在化疗开始后大约五年，并且在化疗结束后至少持续了八年。在调整药物治疗方案后，我们发现接受脾切除术的患者患白血病的风险至少是未接受脾切除术的患者的两倍，晚期霍奇金病患白血病的风险略高于I期疾病。我们的结论是，霍奇金病的化疗大大增加了白血病的风险，这种增加的风险似乎是剂量相关的，不受伴随放疗。此外，对于更晚期的霍奇金病患者和接受脾切除术的患者，风险更大。
To investigate the effect of different treatments for Hodgkin''s disease on the risk of leukemia, we used an international collaborative group of cancer registries and hospitals to perform a case-control study of 163 cases of leukemia following treatment for Hodgkin''s disease. For each case patient with leukemia, three matched controls were chosen who had been treated for Hodgkin''s disease but in whom leukemia did not develop. The use of chemotherapy alone to treat Hodgkin''s disease was associated with a relative risk of leukemia of 9.0 (95 percent confidence interval, 4.1 to 20) as compared with the use of radiotherapy alone. Patients treated with both had a relative risk of 7.7 (95 percent confidence interval, 3.9 to 15). After treatment with more than six cycles of combinations including procarbazine and mechlorethamine, the risk of leukemia was 14-fold higher than after radiotherapy alone. The use of radiotherapy in combination with chemotherapy did not increase the risk of leukemia above that produced by the use of chemotherapy alone, but there was a dose-related increase in the risk of leukemia in patients who received radiotherapy alone. The peak in the risk of leukemia came about five years after chemotherapy began, and a large excess persisted for at least eight years after it ended. After adjusting for drug regimen, we found that patients who had undergone splenectomy had at least double the risk of leukemia of patients who had not, and an advanced stage of Hodgkin''s disease carried a somewhat higher risk of leukemia than Stage I disease. We conclude that chemotherapy for Hodgkin''s disease greatly increases the risk of leukemia and that this increased risk appears to be dose-related and unaffected by concomitant radiotherapy. In addition, the risk is greater for patients with more advanced stages of Hodgkin''s disease and for those who undergo splenectomy.