title: Increased mortality after successful treatment for Hodgkin's disease.
abstract: OBJECTIVE
  To determine the impact of treatment toxicity on long-term survival in pediatric Hodgkin's disease.
  
  
  METHODS
  We studied late events in 387 patients treated for pediatric Hodgkin's disease on four consecutive clinical trials at St Jude Children's Research Hospital from 1968 to 1990. Relative risks, actuarial risks, and absolute excess risks for cause-specific deaths were calculated.
  
  
  RESULTS
  As of April 1997, 316 (82%) of patients were alive, with a median follow-up of 15.1 (range, 2.9 to 28.6) years. In this cohort, which represented 5,623 person-years of follow-up, 71 fatal events resulted from Hodgkin's disease (n=36), second malignancies (n=14), infections (n=7), accidents (n=7), cardiac disease (n=6), and asphyxiation (n=1). The 5-year estimated event-free survival (EFS) for the entire cohort was 79.6%+/-2.1 %, which declined to 63.1%+/-4.4% by 20 years. Cumulative incidences of cause-specific deaths at 25 years were 9.8%+/-1.6% for Hodgkin's disease, 8.1%+/-2.6% for second malignancy, 4.0%+/-1.8% for cardiac disease, 3.9%+/-1.5% for infection, and 2.1%+/-0.8% for accidents. Standardized incidence ratios showed excess risk for all second malignancies (12; 95% confidence interval [CI], 8 to 17), acute myeloid leukemia (81; 95% CI, 16 to 237), solid tumors (11; 95% CI, 7 to 16), and breast cancer (33; 95% CI, 12 to 72). Standardized mortality ratios also showed excess mortality from cardiac disease (22; 95% CI, 8 to 48) and infection (18; 95% CI, 7 to 38).
  
  
  CONCLUSIONS
  Compared with age- and sex-matched control populations, survivors of pediatric Hodgkin's disease who were treated before 1990 face an increased risk of early mortality related to second cancers, cardiac disease, and infection.
authors.affiliation: Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA. melissa.hudson@stjude.org
authors.forename: M M
authors.initials: MM
authors.lastname: Hudson
authors.forename: C A
authors.initials: CA
authors.lastname: Poquette
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.forename: C A
authors.initials: CA
authors.lastname: Greenwald
authors.forename: A
authors.initials: A
authors.lastname: Shah
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.forename: E I
authors.initials: EI
authors.lastname: Thompson
authors.forename: J A
authors.initials: JA
authors.lastname: Wilimas
authors.forename: L E
authors.initials: LE
authors.lastname: Kun
authors.forename: W M
authors.initials: WM
authors.lastname: Crist
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006689:Hodgkin Disease / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007239:Infections / Q000401:mortality; D008297:Male; D016609:Neoplasms, Second Primary / Q000401:mortality; D011878:Radiotherapy / Q000009:adverse effects; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors