Centurioni R, Brianzoni M F, Salvi A, Montillo M, Rupoli S, Olivieri A, Leoni P, Danieli G
Istituto di Clinica Medica Generale e Terapia Medica, Università, Ancona.
Recenti Prog Med. 1993 May;84(5):328-35.
The increase of survival in patients with Hodgkin's disease (HD) has made appear the problem of secondary neoplasms, included acute leukemias. The authors evaluate the incidence of acute leukemias in 205 HD with a follow-up more than 12 months (mean 92 months). With regard to these latter, 18 (8.7%) were treated with radiotherapy alone, 69 (33.6%) with chemotherapy alone and 118 (57.5%) with a combination of radiotherapy and chemotherapy. Chemotherapy consisted of 2-12 courses of MOPP alone or in combination with ABVD. The relative risk of acute leukemias is 96.7 (CI 95%: 44.2-183.6): nine cases against an expectancy of 0.093. The risk changes during five-years periods, but not significantly, and it not declines after ten years from the diagnosis. Only the alkylating chemotherapy seems to be important to favour the onset of acute leukemias. Among the patients who received a number of courses of MOPP less or equal than 6 (177), seven developed an acute leukemia (relative risk 85.3; CI 95%: 34.3-175.9); among those who received more than 6 (9), two developed an acute leukemia (relative risk 333.3; CI 95%: 40.3-1204.1). Neither the addition of radiotherapy nor the stage nor the splenectomy nor the histotype favour the onset of acute leukemia.
霍奇金淋巴瘤（HD）患者生存率的提高使得包括急性白血病在内的继发性肿瘤问题凸显出来。作者评估了205例随访时间超过12个月（平均92个月）的HD患者中急性白血病的发病率。其中，18例（8.7%）仅接受放疗，69例（33.6%）仅接受化疗，118例（57.5%）接受放疗与化疗联合治疗。化疗方案为单独使用2 - 12个疗程的MOPP或与ABVD联合使用。急性白血病的相对风险为96.7（95%置信区间：44.2 - 183.6）：预期为0.093例，实际发生9例。风险在五年期间有所变化，但不显著，且自诊断后十年内未下降。只有烷化剂化疗似乎对急性白血病的发生有重要影响。在接受MOPP疗程数小于或等于6个疗程的患者（177例）中，有7例发生急性白血病（相对风险85.3；95%置信区间：34.3 - 175.9）；在接受超过6个疗程的患者（9例）中，有2例发生急性白血病（相对风险333.3；95%置信区间：40.3 - 1204.1）。放疗的加入、分期、脾切除术或组织学类型均不促进急性白血病的发生。
