Non-Hodgkin's Lymphoma After Treatment of Hodgkin's Disease

To the Editor.  —In the March Archives (1983;143:445-450), Armitage et al reported five cases of non-Hodgkin's lymphomas (NHL) in 242 patients previously treated for Hodgkin's disease (HD) and reviewed 24 other cases from the literature. There are at least three more reported cases.^1-3 The title of the accompanying editorial (1983; 143:427) gave the impression that all of these patients had NHL develop. In fact, at least five of these patients, including at least one of the patients of Armitage et al, had acute lymphoblastic leukemia and not NHL. Acute leukemia, mostly myeloid,⁴ is a well-recognized late complication of therapy for HD. A few cases of lymphoblastic leukemia have also been reported.⁵It seems far from certain that the incidence of second neoplasms, other than acute myeloid leukemia, in patients previously treated for HD is significantly increased. Although Armitage et al cite a minimum incidence of 2.1% of