Acute leukemia after the treatment of Hodgkin's disease

The risk of developing a secondary acute leukemia or myelodysplastic syndrome after the treatment of Hodgkin's disease is discussed on the basis of the results reported from large series with prolonged follow-up. It appears that the risk mainly depends upon the treatment strategy and certain host-related factors such as older age. Radiation therapy used alone is associated with the lowest risk, combination mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy plus irradiation with the highest risk, and the risk of MOPP chemotherapy alone being in between the two. Splenectomy and probably splenic irradiation may also add to the risk. In long-term, surviving patients continuously free of Hodgkin's disease, the cumulative probability of second leukemia is low, with a high risk period which can be limited to the 10 years following the end of curative therapy. Finally, the impact of secondary leukemia on long-term survival is limited and far less than that of second tumors.