How relevant is secondary leukaemia for initial treatment selection in Hodgkins disease?
Specific tools of decision analysis, a set of mathematical rules for simplifying complex decisions, were applied to evaluate the impact of secondary leukaemia on the selection of initial treatment in Hodgkin’s disease (HD). For this purpose, a combined ‘expected utility’ considering survival, relapse free survival, and secondary leukaemia was determined for different treatment strategies. Our analysis revealed that considerations of secondary leukaemia for initial therapy should include the a priori estimation of all possible events which may occur after initial treatment, e.g. the probabilities of recurrence and success of salvage therapy. In early and intermediate stage HD, for example, the minimal risk of leukaemia after successful radiotherapy (RT) must be weighed against the increased risk after treatment failure and subsequent salvage therapy. Thus, the difference of expected risk of leukaemia between RT and combined modality treatment (CMT) is within 4% for HD, stage II B and ne
