霍奇金淋巴瘤治疗中并发的白血病：英国国家淋巴瘤调查的经验

Leukaemia complicating treatment for Hodgkin's disease: the experience of the British National Lymphoma Investigation.

作者信息

Devereux S, Selassie T G, Vaughan Hudson G, Vaughan Hudson B, Linch D C

机构信息

Kent and Canterbury Hospital.

出版信息

BMJ. 1990 Nov 10;301(6760):1077-80. doi: 10.1136/bmj.301.6760.1077.

DOI:10.1136/bmj.301.6760.1077

PMID:2249071

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1664202/

Abstract

OBJECTIVE

To determine the incidence of and risk factors for the development of secondary acute leukaemia and myelodysplasia in patients treated in British National Lymphoma Investigation's studies of Hodgkin's disease since 1970.

PATIENTS

2676 Patients entered into Hodgkin's disease studies between February 1970 and November 1986. Data accrued up to November 1988 were analysed, ensuring a minimum follow up period of two years.

DESIGN

Retrospective analysis of multicentre trial data by case-control and life table methods.

RESULTS

17 Cases of secondary leukaemia were recorded in this group of 2676 patients, giving an overall risk at 15 years of 1.7%. The risks of leukaemia after chemotherapy alone and chemotherapy with radiotherapy were not significantly different. The risk of leukaemia increased sharply with the amount of treatment given as measured by the number of attempts at treatment. The 15 year risks of leukaemia were 0.2%, 2.3%, and 8.1% for patients receiving one, two, or three or more attempts at treatment. The highest risk, 22.8% at 15 years, was observed in patients treated with lomustine (CCNU), and a case-control study suggested that this was an independent risk factor. The risk of secondary leukaemia was largely related to the overall quantity of treatment, although exposure to lomustine seemed to be an important risk factor. Treatment with both drugs and radiation was not more leukaemogenic than treatment with drugs alone. The greatest risk of secondary leukaemia was seen in multiply treated patients who were unlikely to be cured of Hodgkin's disease.

CONCLUSIONS

Avoidance of secondary leukaemia should be a minor factor in the choice of treatment for Hodgkin's disease.

摘要

目的

确定自1970年以来在英国国家淋巴瘤调查的霍奇金病研究中接受治疗的患者发生继发性急性白血病和骨髓增生异常综合征的发病率及危险因素。

患者

1970年2月至1986年11月期间纳入霍奇金病研究的2676例患者。分析截至1988年11月积累的数据，确保最短随访期为两年。

设计

采用病例对照和生命表方法对多中心试验数据进行回顾性分析。

结果

在这2676例患者中记录到17例继发性白血病病例，15年时的总体风险为1.7%。单纯化疗和化疗联合放疗后发生白血病的风险无显著差异。白血病风险随着以治疗尝试次数衡量的治疗量急剧增加。接受1次、2次或3次及以上治疗尝试的患者15年时白血病风险分别为0.2%、2.3%和8.1%。接受洛莫司汀（环己亚硝脲）治疗的患者15年时风险最高，为22.8%，一项病例对照研究表明这是一个独立危险因素。继发性白血病风险在很大程度上与治疗总量相关，尽管接触洛莫司汀似乎是一个重要危险因素。联合使用药物和放疗并不比单纯药物治疗更易致白血病。继发性白血病风险最高见于多次治疗且不太可能治愈霍奇金病的患者。