Journal of Clinical Oncology, Vol 16, 2070-2079, Copyright © 1998 by American Society of Clinical Oncology

ARTICLES

Late effects in long-term survivors of high-grade non-Hodgkin's lymphomas

TB Haddy, MA Adde, J McCalla, MJ Domanski, M Datiles 3rd, SC Meehan, A Pikus, AT Shad, I Valdez, L Lopez Vivino and IT Magrath
Pediatric Oncology Branch, National Cancer Institute, Division of Epidemiology and Clinical Applications, National Institutes of Health, Bethesda, MD, USA.

PURPOSE: To evaluate long-term survivors of high-grade non-Hodgkin's lymphomas (NHLs) for late effects and to attempt to assess the relative contributions of the primary treatment modalities to these late effects. PATIENTS AND METHODS: Of 103 young survivors followed up for 1 to 20 years, 74 patients were interviewed and underwent various investigations, and an additional 12 patients were interviewed only. Of the 86 patients, 65 had previously suffered from small non-cleaved-cell lymphoma, 16 from lymphoblastic lymphoma, and five from large-cell lymphoma. RESULTS: Left ventricular dysfunction was identified in eight of 57 (14.0%) patients who had received doxorubicin (DOX) in doses greater than 200 mg/m2, of whom four were symptomatic and four were asymptomatic. A ninth patient required a pacemaker. Of the 86 patients, 23 (26.7%) reported pregnancies, 18 of whom had 30 children. Two of the 86 (2.3%) patients developed second cancers. Other major late effects included posttransfusion viral hepatitis, eight patients; CNS toxicity, two patients; endocrine impairment, 14 patients; vitamin B12 deficiency, two patients; esophageal stricture, one patient; urinary tract problems, two patients; and musculoskeletal defects, three patients. Major late effects occurred in 11 of 21 (52.4%) patients who had received radiation as well as chemotherapy, eight of 22 (36.4%) patients who had surgical resections as well as chemotherapy, and 17 of 74 (23.0%) patients who had received chemotherapy alone. CONCLUSION: The predominant major late effects observed were late cardiac toxicity related to DOX therapy and hepatitis C virus infection that presumably resulted from blood product transfusions administered before the introduction of screening for the hepatitis C virus. Fertility was not greatly impaired, and second malignancies were uncommon. No patient had clinically significant impairment of growth. Radiation appeared to increase the likelihood of late effects.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				D. L. Hershman, R. B. McBride, A. Eisenberger, W. Y. Tsai, V. R. Grann, and J. S. Jacobson Doxorubicin, Cardiac Risk Factors, and Cardiac Toxicity in Elderly Patients With Diffuse B-Cell Non-Hodgkin's Lymphoma J. Clin. Oncol., July 1, 2008; 26(19): 3159 - 3165. [Abstract] [Full Text] [PDF]

				E. C. Bluhm, C. Ronckers, R. J. Hayashi, J. P. Neglia, A. C. Mertens, M. Stovall, A. T. Meadows, P. A. Mitby, J. A. Whitton, S. Hammond, et al. Cause-specific mortality and second cancer incidence after non-Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study Blood, April 15, 2008; 111(8): 4014 - 4021. [Abstract] [Full Text] [PDF]

				B. L. Frei and S. A. Soefje A Review of the Cardiovascular Effects of Oncology Agents Journal of Pharmacy Practice, April 1, 2008; 21(2): 146 - 158. [Abstract] [PDF]

				Z. Blumenfeld How to Preserve Fertility in Young Women Exposed to Chemotherapy? The Role of GnRH Agonist Cotreatment in Addition to Cryopreservation of Embrya, Oocytes, or Ovaries Oncologist, September 1, 2007; 12(9): 1044 - 1054. [Abstract] [Full Text] [PDF]

				A. Aviles, N. Neri, and M. J. Nambo Long-term evaluation of cardiac function in children who received anthracyclines during pregnancy Ann. Onc., February 1, 2006; 17(2): 286 - 288. [Abstract] [Full Text] [PDF]

				O. Hequet, Q.H. Le, I. Moullet, E. Pauli, G. Salles, D. Espinouse, C. Dumontet, C. Thieblemont, P. Arnaud, D. Antal, et al. Subclinical Late Cardiomyopathy After Doxorubicin Therapy for Lymphoma in Adults J. Clin. Oncol., May 15, 2004; 22(10): 1864 - 1871. [Abstract] [Full Text] [PDF]

				M. Andre, N. Mounier, X. Leleu, A. Sonet, P. Brice, M. Henry-Amar, H. Tilly, B. Coiffier, A. Bosly, P. Morel, et al. Second cancers and late toxicities after treatment of aggressive non-Hodgkin lymphoma with the ACVBP regimen: a GELA cohort study on 2837 patients Blood, February 15, 2004; 103(4): 1222 - 1228. [Abstract] [Full Text] [PDF]

				H. Kattlove and R. J. Winn Ongoing Care of Patients After Primary Treatment for Their Cancer CA Cancer J Clin, May 1, 2003; 53(3): 172 - 196. [Abstract] [Full Text] [PDF]

				S. Limat, K. Demesmay, L. Voillat, Y. Bernard, E. Deconinck, A. Brion, A. Sabbah, M. C. Woronoff-Lemsi, and J. Y. Cahn Early cardiotoxicity of the CHOP regimen in aggressive non-Hodgkin's lymphoma Ann. Onc., February 1, 2003; 14(2): 277 - 281. [Abstract] [Full Text] [PDF]

				T. B. Haddy, R. B. Mosher, and G. H. Reaman Osteoporosis in Survivors of Acute Lymphoblastic Leukemia Oncologist, June 1, 2001; 6(3): 278 - 285. [Abstract] [Full Text] [PDF]