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Symptomatic osteonecrosis as a treatment complication in Hodgkin lymphoma: an analysis of the German Hodgkin Study Group (GHSG)

Leukemiavolume 33pages439446 (2019) | Download Citation


The majority of patients with Hodgkin Lymphoma (HL) can be cured with stage and risk adapted treatment today. Therefore, current research focuses on reducing long-term sequelae of treatment. Osteonecrosis (ON) is a severe long-term complication of HL treatment which has so far not been systematically evaluated. Hence, we investigated incidence, risk factors and timing of symptomatic ON in HL patients. Further endpoints included localization, intervention and outcome of ON. We included all qualified HL patients of the randomized German Hodgkin Study Group trials HD10-15 and HD18, recruited between 05/1998 and 07/2014 and aged from 16 to 60 years. Among 11 330 patients, 66 developed symptomatic ON after first-line treatment, 83.3% within three years. The incidence of symptomatic ON was 0.2% in early-stage HL and 1.0% in advanced-stage HL. Logistic regression revealed the total cumulative corticosteroid dose to be a strong risk factor interacting with younger age. Male sex additionally increased the risk of symptomatic ON. The prognostic value of the corresponding logistic regression model was rather high (AUC = 0.78). Other tested potential risk factors including obesity, IPS and radiotherapy did not further increase the risk of ON. Further development of current treatment protocols should aim to reduce the cumulative corticosteroid dose.

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This study was presented in part at the 21st annual congress of the European Hematology Association (EHA) in Copenhagen, Denmark in June 2016 and at the 10th International Symposium on Hodgkin Lymphoma (ISHL) in October 2016 in Cologne, Germany. This study was supported by grants of the Deutsche Krebshilfe e.V. (German Cancer Aid) for the HD10-HD15 and HD18 trials.

Author information


  1. Department I of Internal Medicine and German Hodgkin Study Group (GHSG), University Hospital of Cologne, Cologne, Germany

    • Sven Borchmann
    • , Horst Müller
    • , Michael Fuchs
    • , Peter Borchmann
    •  & Andreas Engert
  2. Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany

    • Heinz Haverkamp
  3. Department of Radio-Oncology, University Hospital of Cologne, Cologne, Germany

    • Christian Baues
  4. Department for Internal Medicine and Hematology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic

    • Jana Marková
  5. Department of Haematology, University Hospital, University Duisburg-Essen, Duisburg, Germany

    • Andreas Hüttmann
    •  & Axel Glunz


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The authors declare that they have no conflict of interest.

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Correspondence to Andreas Engert.

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