Second malignancy complicating Hodgkin's disease

We have reviewed the records of 227 patients with Hodgkin's disease diagnosed between 1969 and 1977 inclusively. The incidence of a second malignancy has been assessed. Fourteen patients developed second malignancies, 10 of which were solid tumors and four acute leukemias. The ratios of observed to expected malignancies were assessed for three subgroups: it was 1.58 for patients who received radiotherapy alone, 5.17 for patients who received combined radiotherapy and chemotherapy, and 14.73 for a third subgroup of patients who also received maintenance chemotherapy. A detailed analysis of the 14 patients with a second malignancy has been done. Only one occurred in a patient who had had a splenectomy. Patients who had a relapse of Hodgkin's disease did not have an increased incidence of second malignancy. Treatment-induced malignancies appear to be rather aggressive. Of the 14 patients, 12 died within one year and two are alive with disease, one year after diagnosis.