John Libbey Eurotext

Hématologie

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Long-term complications after Hodgkin’s disease Volume 6, issue 2, Mars - Avril 2000

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The use of appropriate staging techniques and treatment strategies adapted to disease presentation has dramatically increased survival rates. However, late complications faced by survivors after Hodgkin’s disease are now better known, because a greater number of successfully treated patients are followed for longer period of time. Secondary malignancies are the most serious because they are often fatal. Malignant complications are mostly treatment-induced. Among antimitotics, alkylating agents have been implicated in the development of secondary leukemia. Radiation therapy in certain cases increases the risk of secondary solid tumors ; however, the exact role of radiation therapy as a risk factor, remains to be assessed. Hodgkin’s disease therapy may result in nonmalignant complications, that concern mostly severe infections, myocardial infarction and cardiovascular dysfunction, pulmonary, thyroid or gonadal dysfunction. Clinical staging, modern irradiation techniques and new strategies have resulted in a lower incidence of digestive complications, chronic pericarditis and skeletal complications in children. In large series published, two late complications appeared as the cause of long-term overmortality 20 years later : myocardial infarction and secondary cancers. Psychologic and social disturbance after treatment, and late complications can interfere with survivors’ quality of life. Treatment choice should take into account long-term complications, and Hodgkin’s disease survivors should be submitted to routine follow-up for the rest of their lives.