title: Long-term effects of high-dose chemotherapy and radiation for relapsed and refractory Hodgkin's lymphoma.
abstract: OBJECTIVE
  To evaluate the risk of late morbidity and mortality, and to assess long-term health-related quality of life (QOL) among patients with relapsed/refractory Hodgkin's lymphoma (HL) after high-dose chemoradiotherapy (HDT) and autologous stem-cell rescue (ASCR).
  
  
  METHODS
  From 1985 to 1998, 218 patients with HL were treated on HDT with ASCR salvage protocols. Of these 218, 153 (70%) who survived > or = 2 years after ASCR were evaluated for late morbidity and mortality from causes other than HL. QOL information was obtained through self-administered questionnaires. Risk ratios (RR) were calculated to compare observed second malignancy (SM) rates in this cohort with expected SM rates from the Surveillance Epidemiology and End Results (SEER) registry.
  
  
  RESULTS
  Median follow-up after ASCR was 11.5 years. Among 153 patients, there were 53 deaths; 33 from HL and 20 from other causes. Thirteen deaths were caused by SM, with median time from ASCR to SM diagnosis of 9 years (range, 3 to 18 years). The RR of SM was 6.5 (95% CI, 3.6 to 10.7) when compared with the general population, but 2.4 (95% CI, 1.4 to 4.05) when compared with patients with HL. Global QOL of ASCR survivors was comparable with the general population, but for specific domains, respondents' scores indicated reduced functioning and worse symptoms.
  
  
  CONCLUSIONS
  HL accounts for most deaths among patients surviving HDT and ASCR. Survivors of ASCR had an elevated risk of SM compared with the cancer risk in the general population, but when compared with patients with HL in SEER, the risk was less pronounced.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. goodmank@mskcc.org
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
authors.forename: Elyn
authors.initials: E
authors.lastname: Riedel
authors.forename: Victoria
authors.initials: V
authors.lastname: Serrano
authors.forename: Subhash
authors.initials: S
authors.lastname: Gulati
authors.forename: Craig H
authors.initials: CH
authors.lastname: Moskowitz
authors.forename: Joachim
authors.initials: J
authors.lastname: Yahalom
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D019008:Drug Resistance, Neoplasm; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D018570:Risk Assessment; D018426:SEER Program; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D011795:Surveys and Questionnaires; D013997:Time Factors; D014182:Transplantation, Autologous; D017211:Treatment Failure