During the last 30 years, combined chemotherapy regimens with radiotherapy or not significantly improved the prognosis for patients with Hodgkin lymphoma. We retrospectively studied 58 children (35 boys and 23 girls) with Hodgkin lymphoma who were treated at our institution during the period 1987–2006 and we correlated age, sex, stage, histology, and therapy with the outcome of patients. Of our patients, 9 children were 8 years old or younger. Nodular sclerosis was the predominant histology subtype (69%), whereas 26 patients (45%) had advanced disease (stage III or IV). Chemotherapy (CT) with various drug combinations, according to the period of treatment plus low-dose involved field radiation therapy (IFRT), was used in all patients. Five children experienced relapse and in 3 other patients second or third malignancies were documented. The overall survival was found to be 98%. No factors related to the outcome could be detected. The prognosis of children with Hodgkin lymphoma is excellent with CT combined with low dose IFRT but in long-time survivors late effects of the combined modality treatment are still issues of major concern. Longer followup of a greater number of patients is necessary to detect prognostic factors related to the outcome of children with Hodgkin lymphoma and to identify some patients who would be treated without radiation. 1. Introduction In Europe and USA Hodgkin lymphoma (HL) is the sixth most common type of cancer in children following leukemia, CNS tumors, neuroblastoma, nephroblastoma, and non Hodgkin lymphomas, accounting for approximately 5% of all childhood malignancies. The prevalence of disease varies considerably with age, gender, nationality, and histology subtype. According to data of International Agency for Research on Cancer (IARC) for children younger than 15 years, the incidence is 5.5 cases per million but for those aged 15–20 years the incidence reaches 12.1 cases per million. In Western Asia (extending from the Mediterranean to Northwest India) the incidence in children <15 years old is consistently higher than 7 cases per million [1]. In Greece, the annual incidence is 7.2 per million children [2]. The disease presents a characteristically bimodal curve with an early peak in adolescence and a second peak in adults aged above 50 years old, whereas is very rare in children under 5 years of age. Patients (pts) with HL commonly present with cervical or supraclavicular lymphadenopathy and with mediastinal involvement in most of them. Treatment is largely determined by disease stage, patient’s age at diagnosis, the
References
[1]
J. Gurney and M. Bondy, “Epidemiology of childhood cancer,” in Principles and Practice of Pediatric Oncology, A. P. Pizzo and D. G. Poplack, Eds., chapter 1, pp. 1–13, Lippincott-Raven, Philadelphia, Pa, USA, 5th edition, 2006.
[2]
E. T. Petridou, A. Pourtsidis, N. Dessypris et al., “Childhood leukaemias and lymphomas in Greece (1996–2006): a nationwide registration study,” Archives of Disease in Childhood, vol. 93, no. 12, pp. 1027–1032, 2008.
[3]
M. Hudson, M. Onciu, and S. Donaldson, “Hodgkin’s disease,” in Principles and Practise of Pediatric Oncology, P. Pizzo and D. Poplack, Eds., pp. 695–721, Lippincott-Raven, Philadelphia, Pa, USA, 5th edition, 2006.
[4]
S. S. Donaldson, M. P. Link, H. J. Weinstein et al., “Final results of a prospective clinical trial with VAMP and low-dose involved-field radiation for children with low-risk Hodgkin's disease,” Journal of Clinical Oncology, vol. 25, no. 3, pp. 332–337, 2007.
[5]
A. Oguz, C. Karadeniz, F. V. Okur et al., “Prognostic factors and treatment outcome in childhood Hodgkin disease,” Pediatric Blood and Cancer, vol. 45, no. 5, pp. 670–675, 2005.
[6]
M. M. Hudson, M. Krasin, M. P. Link et al., “Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin's disease,” Journal of Clinical Oncology, vol. 22, no. 22, pp. 4541–4550, 2004.
[7]
T. A. Lister, D. Crowther, S. B. Sutcliffe et al., “Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: cotswolds meeting,” Journal of Clinical Oncology, vol. 7, no. 11, pp. 1630–1636, 1989.
[8]
E. L. Weinshel and B. A. Peterson, “Hodgkin's disease,” Ca-A Cancer Journal for Clinicians, vol. 43, no. 6, pp. 327–346, 1993.
[9]
O. Oberlin, G. Leverger, H. Pacquement et al., “Low-dose radiation therapy and reduced chemotherapy in childhood Hodgkin's disease: the experience of the French Society of pediatric oncology,” Journal of Clinical Oncology, vol. 10, no. 10, pp. 1602–1608, 1992.
[10]
J. Landman-Parker, H. Pacquement, T. Leblanc et al., “Localized childhood Hodgkin's disease: response-adapted chemotherapy with etoposide, bleomycin, vinblastine, and prednisone before low-dose radiation therapy—results of the French society of pediatric oncology study MDH90,” Journal of Clinical Oncology, vol. 18, no. 7, pp. 1500–1507, 2000.
[11]
A. L. Feldman, S. Pittaluga, and E. S. Jaffe, “Classification and histopathology of the lymphomas,” in The Lymphomas, G. P. Canellos, T. A. Lister, and B. Young, Eds., pp. 2–25, Saunders Elsevier, Philadelphia, Pa, USA, 2nd edition, 2006.
[12]
L. Nogová, T. Rudiger, and A. Engert, “Biology, clinical course and management of nodular lymphocyte-predominant hodgkin lymphoma,” Hematology, pp. 266–272, 2006.
[13]
R. S. Smith, Q. Chen, M. M. Hudson et al., “Prognostic factors for children with Hodgkin's disease treated with combined-modality therapy,” Journal of Clinical Oncology, vol. 21, no. 10, pp. 2026–2033, 2003.
[14]
C. L. Schwartz, “Prognostic factors in pediatric Hodgkin disease,” Current Oncology Reports, vol. 5, no. 6, pp. 498–504, 2003.
[15]
A. Belgaumi, A. Al-Kofide, N. Joseph, R. Jamil-Malik, Y. Khafaga, and R. Sabbah, “Hodgkin lymphoma in very young children: clinical characteristics and outcome of treatment,” Leukemia and Lymphoma, vol. 49, no. 5, pp. 910–916, 2008.
[16]
G. A. Viani, M. S. Castilho, P. E. Novaes et al., “Chemotherapy followed by low dose radiotherapy in childhood Hodgkin's disease: retrospective analysis of results and prognostic factors,” Radiation Oncology, vol. 1, pp. 38–45, 2006.
[17]
V. Dinand, R. Dawar, L. S. Arya, R. Unni, B. Mohanty, and R. Singh, “Hodgkin's lymphoma in Indian children: prevalence and significance of Epstein-Barr virus detection in Hodgkin's and Reed-Sternberg cells,” European Journal of Cancer, vol. 43, no. 1, pp. 161–168, 2007.
[18]
T. Portis, P. Dyck, and R. Longnecker, “Epstein-Barr Virus (EBV) LMP2A induces alterations in gene transcription similar to those observed in Reed-Sternberg cells of Hodgkin lymphoma,” Blood, vol. 102, no. 12, pp. 4166–4178, 2003.
[19]
O. Landgren, E. A. Engels, R. M. Pfeiffer et al., “Autoimmunity and susceptibility to Hodgkin lymphoma: a population-based case-control study in Scandinavia,” Journal of the National Cancer Institute, vol. 98, no. 18, pp. 1321–1330, 2006.
[20]
C. L. Schwartz, “The management of Hodgkin disease in the young child,” Current Opinion in Pediatrics, vol. 15, no. 1, pp. 10–16, 2003.
[21]
V. Diehl, H. Stein, M. Hummel, R. Zollinger, and J. M. Connors, “Hodgkin's lymphoma: biology and treatment strategies for primary, refractory, and relapsed disease,” Hematology, pp. 225–247, 2003.
[22]
N. L. Bartlett, “Modern treatment of Hodgkin lymphoma,” Current Opinion in Hematology, vol. 15, no. 4, pp. 408–414, 2008.
[23]
A. F. Cashen and N. L. Bartlett, “Therapy of relapsed hodgkin lymphoma,” Blood Reviews, vol. 21, no. 5, pp. 233–243, 2007.
[24]
M. B. Bradley and M. S. Cairo, “Stem cell transplantation for pediatric lymphoma: past, present and future,” Bone Marrow Transplantation, vol. 41, no. 2, pp. 149–158, 2008.
[25]
E. Brusamolino and A. M. Carella, “Treatment of refractory and relapsed Hodgkin's lymphoma: facts and perspectives,” Haematologica, vol. 92, no. 1, pp. 6–10, 2007.
[26]
A. K. Ng and P. M. Mauch, “The impact of treatment on the risk of second malignancy after Hodgkin's disease,” Annals of Oncology, vol. 17, no. 12, pp. 1727–1729, 2006.
[27]
M. R. Olson and S. S. Donaldson, “Treatment of pediatric hodgkin Lymphoma,” Current Treatment Options in Oncology, vol. 9, no. 1, pp. 81–94, 2008.
[28]
M. Fuchs, V. Diehl, and D. Re, “Current strategies and new approaches in the treatment of Hodgkin's lymphoma,” Pathobiology, vol. 73, no. 3, pp. 126–140, 2006.
[29]
J. B. Nachman, R. Sposto, P. Herzog et al., “Randomized comparison of low-dose involved-field radiotherapy and no radiotherapy for children with Hodgkin's disease who achieve a complete response to chemotherapy,” Journal of Clinical Oncology, vol. 20, no. 18, pp. 3765–3771, 2002.
[30]
M. E. Juweid, “Utility of positron emission tomography (PET) scanning in managing patients with Hodgkin lymphoma,” Hematology, pp. 259–265, 2006.
