Salvagno L, Simonato L, Sorarù M, Bianco A, Chiarion-Sileni V, Aversa S M, Camporese R, Garofolin P, Fiorentino M
Divisione di Oncologia Medica, Centro Oncologico Regionale, Padua, Italy.
Tumori. 1993 Apr 30;79(2):103-7. doi: 10.1177/030089169307900204.
Patients treated for Hodgkin's disease with chemotherapy or with the association of chemotherapy and radiotherapy have an increased risk of secondary leukemia. The aim of this study was to evaluate the leukemogenic risk due to these treatment modalities.
We performed a case-control study on a population of 1410 patients treated for Hodgkin's disease from 1970 to 1990 in our Institute. Among these patients, we identified 25 cases of secondary leukemia and 3 cases of myelodysplasia, all occurring more than one year after the diagnosis of Hodgkin's disease. Three cases occurred among the patients treated with radiotherapy alone. When we analyzed the risk in relation to the type of treatment (radiotherapy, chemotherapy, or both), the comparisons were relative to patients treated with radiotherapy alone.
We found that chemotherapy alone is associated with a fivefold increased risk (odds ratio = 5.4) compared with radiotherapy alone. When both treatments are used, the risk is not further increased (odds ratio = 4.4). Patients receiving more than 6 courses of chemotherapy have an excess risk (relative risk = 2.5) compared with those treated with 6 courses or less. No increased risk was observed after splenectomy.
This study confirms an increased incidence of secondary leukemia occurring in patients treated for Hodgkin's disease. The increased risk seems to be correlated with the number of courses of alkylating agent therapy, whereas it is unaffected by the addition of radiotherapy.
接受化疗或化疗联合放疗治疗的霍奇金病患者发生继发性白血病的风险增加。本研究的目的是评估这些治疗方式导致白血病的风险。
我们对1970年至1990年在我院接受霍奇金病治疗的1410名患者进行了病例对照研究。在这些患者中，我们确定了25例继发性白血病和3例骨髓发育异常，均发生在霍奇金病诊断后一年以上。3例发生在仅接受放疗的患者中。当我们分析与治疗类型（放疗、化疗或两者）相关的风险时，比较是相对于仅接受放疗的患者。
我们发现，与仅接受放疗相比，单纯化疗的风险增加了五倍（优势比=5.4）。当两种治疗都使用时，风险没有进一步增加（优势比=4.4）。接受超过6个疗程化疗的患者与接受6个疗程或更少疗程化疗的患者相比，风险过高（相对风险=2.5）。脾切除术后未观察到风险增加。
本研究证实接受霍奇金病治疗的患者继发性白血病的发病率增加。风险增加似乎与烷化剂治疗的疗程数相关，而不受放疗的影响。
