This article describes four cases of non-Hodgkin's lymphomas occurring after successful treatment of Hodgkin's disease (HD). The clinical symptoms consisted of digestive disorders, and the histology confirmed an intestinal involvement in these four patients. In all cases patients had diffuse large cell types (intermediate or high grade). The respective role of H D treatment (combination chemotherapy in 3 of 4 patients with irradiation in 3 of 4 patients) and of other pathogenic hypotheses, are discussed. Cancer 53:459-462, 1984. HE INCIDENCE of second neoplasms after successful
T treatment of Hodgkin's disease (HD) with either radiotherapy, chemotherapy or both, has been recognized for many years. The majority of these second neoplasms are acute myeloblastic leukemia (AML)1-2' with a risk of about 2% at 7 years," increasing to 5% at 5 years in patients treated with both radiotherapy and chemotherapy." This risk level and the delay in the appearance of AML suggests a causal connection between AML and the treatment of HD. Solid tumors have also been described, but these occur much less f r e q ~e n t l y . ~-~* ' ~ However, to date only 20 cases of non-Hodgkin's lymphoma (NHL) have been of which 9 come from two large groups, 1 of 6 patients reported by Krikorian et a1.28 and the other of 3 cases described by Kim et al." We report here another four cases of NHL occumng after successful treatment of treated HD (Table ). All of the diagnostic slides were reviewed by four histologists (Professor C. Brocheriou, A. de Roquancourt, MF. d'Agay, and G. Tricot) all of whom agreed on the diagnosis.