{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T02:47:30Z","timestamp":1773974850615,"version":"3.50.1"},"reference-count":31,"publisher":"American Society of Hematology","issue":"11","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,3,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Survivors of Hodgkin lymphoma (HL) have an increased risk of subsequent malignant neoplasms (SMNs). Response-adapted treatment may decrease this risk by reducing exposure to therapy associated with SMN risk. The Children\u2019s Oncology Group study AHOD0031 evaluated response-adapted therapy for children and adolescents with intermediate-risk HL. We report the SMNs among 1711 patients enrolled in AHOD0031. Patients were treated with 4 cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide with or without involved-field radiation therapy (RT). Patients with a slow early response to initial chemotherapy were randomized to 2 additional cycles of dexamethasone, etoposide, cisplatin and cytarabine or no additional chemotherapy, and all received RT. At a median follow-up of 7.3 years, an analysis of SMNs was performed. The 10-year cumulative incidence of SMN was 1.3% (95% confidence interval [CI], 0.6-2.0). SMNs included 3 patients with acute myeloid leukemia (AML), 11 with solid tumors, and 3 with non-Hodgkin lymphoma. Sixteen of 17 patients with an SMN had received combined modality therapy. The standardized incidence ratio for SMN was 9.5 (95% CI, 4.5-15.2) with an excess absolute risk of 1.2 per 1000 person-years. The cumulative incidence of SMNs was higher among patients who received RT (P = .037). In multivariate analysis, RT, B symptoms, and race were associated with SMN risk. Given the latency from exposure, we have likely captured all cases of secondary leukemia and myelodysplastic syndrome (MDS). Longer follow-up is needed to determine the risk of solid tumors. Avoidance of RT without sacrificing disease control should remain a goal for future therapeutic approaches. This trial was registered at www.clinicaltrials.gov as #NCT00025259.<\/jats:p>","DOI":"10.1182\/blood.2020007225","type":"journal-article","created":{"date-parts":[[2020,12,19]],"date-time":"2020-12-19T05:46:57Z","timestamp":1608356817000},"page":"1449-1456","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":24,"title":["Subsequent malignant neoplasms among children with Hodgkin lymphoma: a report from the Children\u2019s Oncology Group"],"prefix":"10.1182","volume":"137","author":[{"given":"Lisa","family":"Giulino-Roth","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Weill Cornell Medical College, New York, NY;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinglin","family":"Pei","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Florida, Gainesville, FL;"},{"name":"Children\u2019s Oncology Group Statistics and Data Center, Gainesville, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allen","family":"Buxton","sequence":"additional","affiliation":[{"name":"Children\u2019s Oncology Group Statistics and Data Center, Monrovia, CA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rizvan","family":"Bush","sequence":"additional","affiliation":[{"name":"Children\u2019s Oncology Group Statistics and Data Center, Monrovia, CA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Florida, Gainesville, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5234-4134","authenticated-orcid":false,"given":"Suzanne L.","family":"Wolden","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis S.","family":"Constine","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and"},{"name":"Department of Pediatrics, James P. 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