Acute nonlymphocytic leukemia after treatment for Hodgkin's disease.

Eight cases of acute nonlymphocytic leukemia and one case of complicating non-Hodgkin's lymphoma were seen over a 15-year period in 408 patients treated for Hodgkin's disease (actuarial risk of acute nonlymphocytic leukemia of 4.9 percent at 12 years). Two cases of leukemia occurred 11 years after diagnosis of Hodgkin's disease. All nine complications were observed in the 220 patients who received MOPP combination therapy (9.1 percent risk of acute nonlymphocytic leukemia at 12 years) either with (n = 8) or without (n = 1) radiation therapy. Patients treated with MOPP with pathologic stage IV disease (37.2 percent risk of acute nonlymphocytic leukemia at 12 years) or over the age of 40 years (33.1 percent risk), and those with failure of MOPP treatment (18.0 percent risk) were in particular jeopardy. If MOPP treatment had been restricted to patients who were under the age of 40 years and with stages I, II, and III disease, it would have been possible to use the drug combination in two thirds of those who had been so treated while eliminating all but one case of leukemia. Furthermore, leukemia was not observed in 78 patients treated with six cycles of MOPP and less than total nodal irradiation. A final decision concerning optimal management of Hodgkin's disease will require definition of the leukemia incidence curve in the second decade after MOPP treatment, and acquisition of additional knowledge of the long-term efficacy and toxicity of alternate treatment regimens.