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Sekundärneoplasien nach erfolgreicher Primärtherapie des malignen Hodgkin-Lymphoms

Secondary malignancies after successful primary treatment of malignant Hodgkin’s lymphoma

  • Schwerpunkt: Iatrogene Pathologie
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Zusammenfassung

Das maligne Hodgkin-Lymphom (HL) ist durch die fortschreitende Entwicklung der Behandlungsintensität eine heilbare Erkrankung geworden. Allerdings kann dieses aggressive Vorgehen, das häufig Strahlen- und Chemotherapie kombiniert, u. a. sekundäre Neoplasien zur Folge haben.

Die Deutsche Hodgkin-Lymphom Studiengruppe führte 3 Studiengenerationen mit 5411 Patienten in allen Stadien des HL durch. Insgesamt konnten 127 Patienten mit soliden Tumoren identifiziert werden (kumulatives Risiko 2%, mediane Nachbeobachtung 72 Monate), unter denen vor allem Bronchialkarzinome (23,6%) und kolorektale Adenokarzinome (20,5%) am häufigsten waren. Eine sekundäre akute myeloische Leukämie trat bei 36 Patienten auf, weitere 10 zeigten ein myelodysplastisches Syndrom (kumulatives Risiko 1%, mediane Nachbeobachtung 55 Monate). Bei 52 Patienten entwickelte sich ein Non-Hodgkin-Lymphom (NHL; kumulatives Risiko 0,9%, mediane Nachbeobachtung 46 Monate). Insgesamt entwickelte sich bei 3,9% der HL-Patienten nach einer erfolgreichen Chemo- und/oder Radiotherapie eine Sekundärneoplasie.

Die NHL können besondere Schwierigkeiten in der Abgrenzung zum initialen HL bieten, weshalb bei jedem fraglichen Rezidiv eine vollständige histomorphologische Abklärung erfolgen muss.

Abstract

Malignant Hodgkin’s lymphoma (HL) has become a curable disease through the increasing intensity of the treatment strategies applied. These regimens are aggressive, including radiotherapy and chemotherapy leading to the possibility of secondary malignancies.

The German Hodgkin Lymphoma Study Group considered three cohorts including 5,411 patients with all stages of HL. In 127 patients a secondary solid tumor was diagnosed (cumulative risk 2%, median follow-up 72 months), with bronchial carcinomas (23.6%) and colorectal adenocarcinomas (20.5%) being the most frequent neoplasms. Secondary acute myeloid leukemia was found in 36 patients, another ten developed myeloid dysplasia (cumulative risk 1%, median follow-up 55 months). A total of 52 patients revealed a non-Hodgkin’s lymphoma (NHL; cumulative risk 0.9%, median follow-up 46 months). The overall incidence of secondary malignancies was 3.9% in patients who had been treated successfully for their HL with radio- and/or chemotherapy.

A secondary NHL can be particularly difficult to be distinguished from the preceding HL. Therefore, in case of a suspected relapse, a complete histopathological work-up must be performed.

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Authors and Affiliations

  1. Klinik I für Innere Medizin, Universität zu Köln

    P. Borchmann, K. Behringer, A. Josting, J. U. Rueffer, R. Schnell, V. Diehl & A. Engert

  2. Institut für Pathologie, Universität zu Köln

    H. M. Kvasnicka &  J. Thiele

  3. Institut für Pathologie, Universität zu Köln, Joseph-Stelzmannstraße 9, 50924, Köln

    J. Thiele

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  1. P. Borchmann
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  2. K. Behringer
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  4. J. U. Rueffer
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  5. R. Schnell
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  6. V. Diehl
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  8. H. M. Kvasnicka
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  9. J. Thiele
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Correspondence to J. Thiele.

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Borchmann, P., Behringer, K., Josting, A. et al. Sekundärneoplasien nach erfolgreicher Primärtherapie des malignen Hodgkin-Lymphoms. Pathologe 27, 47–52 (2006). https://doi.org/10.1007/s00292-005-0811-0

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  • DOI: https://doi.org/10.1007/s00292-005-0811-0

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