title: Late effects in long-term survivors of high-grade non-Hodgkin's lymphomas.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, Division of Epidemiology and Clinical Applications, National Institutes of Health, Bethesda, MD, USA.
authors.forename: T B
authors.initials: TB
authors.lastname: Haddy
authors.forename: M A
authors.initials: MA
authors.lastname: Adde
authors.forename: J
authors.initials: J
authors.lastname: McCalla
authors.forename: M J
authors.initials: MJ
authors.lastname: Domanski
authors.forename: M
authors.initials: M
authors.lastname: Datiles
authors.forename: S C
authors.initials: SC
authors.lastname: Meehan
authors.forename: A
authors.initials: A
authors.lastname: Pikus
authors.forename: A T
authors.initials: AT
authors.lastname: Shad
authors.forename: I
authors.initials: I
authors.lastname: Valdez
authors.forename: L
authors.initials: L
authors.lastname: Lopez Vivino
authors.forename: I T
authors.initials: IT
authors.lastname: Magrath
mesh_terms: D000293:Adolescent; D000328:Adult; D002493:Central Nervous System Diseases / Q000150:complications / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004700:Endocrine System Diseases / Q000150:complications / Q000453:epidemiology; D004940:Esophageal Stenosis / Q000150:complications / Q000453:epidemiology; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007246:Infertility / Q000150:complications / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D009140:Musculoskeletal Diseases / Q000150:complications / Q000453:epidemiology; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000453:epidemiology; D017741:Survivors; D014570:Urologic Diseases / Q000150:complications / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000453:epidemiology; D014806:Vitamin B 12 Deficiency / Q000150:complications / Q000453:epidemiology