title: Intercurrent death after Hodgkin disease therapy in radiotherapy and adjuvant MOPP trials.
abstract: OBJECTIVE
  To assess long-term differences in mortality associated with initial Hodgkin disease therapy.
  
  
  METHODS
  Retrospective review of patients treated in prospectively randomized clinical trials.
  
  
  METHODS
  Three hundred twenty-six patients with pathologic stage I, II, or III, A or B Hodgkin disease treated between 1967 and 1980 with median follow-up exceeding 14 years.
  
  
  METHODS
  Patients at the same stage of disease were randomized to receive radiation alone (167 patients) or radiation followed by 6 cycles of mechlorethamine hydrochloride, vincristine, procarbazine, and prednisone (MOPP) chemotherapy (159 patients) with additional therapy for progression or recurrence.
  
  
  RESULTS
  No significant differences between treatment regimens for actuarial survival, intercurrent disease, or Hodgkin disease mortality were seen. Thirty-three patients who received radiation alone and 30 patients who received adjuvant chemotherapy died without evident Hodgkin disease. Death was caused by second neoplasms in 28 patients (relative risk, 2.35; 95% CI, 1.46 to 3.24). Six patients developed acute myelogenous leukemia or a myeloproliferative disorder after treatment including MOPP. Chemotherapy exposure varied among the 8 patients with lung cancers, 6 with gastrointestinal and 3 with other adenocarcinomas, 3 with sarcomas, 1 with diffuse large cell lymphoma, and 1 with melanoma. Acute myocardial infarction caused 9 of 17 cardiovascular disease deaths with 5 occurring in patients between the ages of 33 and 43. Nonetheless, the risk for acute myocardial infarction was not clearly increased (relative risk, 0.86; 95% CI, 0.42 to 1.57). Fifteen patients died from infection: 5, opportunistic; 5, asplenic sepsis; and 5, other pneumonias. Two patients died in accidents, and 1 died from radiation pneumonitis.
  
  
  CONCLUSIONS
  Adjuvant MOPP chemotherapy improved freedom from relapse without significant survival benefit or impairment. Leukemogenesis was the only lethal complication associated with MOPP. Survivors of Hodgkin disease had an increased risk for death from a second neoplasm, but no apparent increased risk for death from acute myocardial infarction.
authors.affiliation: Stanford University Medical Center, California.
authors.forename: S L
authors.initials: SL
authors.lastname: Hancock
authors.forename: R T
authors.initials: RT
authors.lastname: Hoppe
authors.forename: S J
authors.initials: SJ
authors.lastname: Horning
authors.forename: S A
authors.initials: SA
authors.lastname: Rosenberg
mesh_terms: D000206:Actuarial Analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D006801:Humans; D008466:Mechlorethamine / Q000627:therapeutic use; D009378:Neoplasms, Multiple Primary / Q000401:mortality; D009894:Opportunistic Infections / Q000401:mortality; D011241:Prednisone / Q000627:therapeutic use; D011344:Procarbazine / Q000627:therapeutic use; D011897:Random Allocation; D012189:Retrospective Studies; D012306:Risk; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D011241:Prednisone