Childhood Hodgkin’s disease survival and prognostic factors; a single centre experience

Abstract

Aim: The aim of this study is to analyze the response and survival rate of pediatric Hodgkin rsquo;s disease and investigate the parameters influencing the survival Material and Method: Forty three Hodgkin rsquo;s disease HD patients who were treated in our Pediatric Hematology Oncology Department between 1996 2011 were retrospectively analyzed Twenty three male and 20 female patients who were younger than 18 year newly diagnosed and untreated were included in the study Results: The median age was nine years five months; one patient had stage I 21 patients had stage II 12 patients had stage III and nine patients had stage IV disease Nineteen patients were in early stage disease and 24 patients were in advanced stage disease The most common histological subtype was nodular sclerosis 22 patients Eighteen of the patients had B symptoms Hemoglobin levels leukocyte count erythrocyte sedimentation rates serum copper fibrinogen lactic dehydrogenase ferritin and haptoglobin levels were analyzed for response to treatment Thirty eight patients are alive seven patients relapsed and five patients died The median follow up period was seven years four months Mean overall survival was 12 66 plusmn;0 70 years Five year overall survival was 85 99 Mean overall survival for early stages was 13 10 plusmn;0 81 years and 12 56 plusmn;0 96 years for late stages Conclusions: Bulky disease was bad prognostic factor for OS Female sex bulky disease and nodular sclerosis histological subtype were adverse prognostic factors for disease free survival Turk Arch Ped 2013; 48: 310 4

Keywords

• Hodgkin’s disease, prognosis, nodular sclerosis

Çocukluk çağı Hodgkin hastalığında sağkalım ve seyri etkileyen değişkenler; tek merkez deneyimi

Öz

Amaç: Bu çalışmanın amacı çocuk Hodgkin hastalığında hastaların yaşam süresi ve tedaviye yanıtını inceleyerek sağkalımı etkileyen değişkenleri araştırmaktır Gereç ve Yöntem: Hastanemiz Çocuk Hematoloji Onkoloji Kliniği rsquo;nde 1996 2011 yılları arasında izlenen ve tedavi edilen 43 Hodgkin lenfoma hastası geriye dönük olarak incelendi On sekiz yaş altında yeni tanı almış 23 erkek ve 20 kız hasta çalışmaya dahil edildi Bulgular: Ortanca yaş dokuz yıl beş ay olup bir hasta evre I 21 hasta evre II 12 hasta evre III ve dokuz hasta evre IV idi Hastalar erken evre ve ileri evre olarak sınıflandırıldı Evre I evre IIA ve düşük riskli evre IIB hastalar erken evre evre III evre IV ve yüksek riskli evre IIB hastalar ileri evre olarak değerlendirildi On dokuz hasta erken evre 24 hasta ileri evre idi En sık histolojik alt tip 22 hasta ile nodüler sklerozan tipti On sekiz hastada B bulguları vardı Çalışmada hemoglobin düzeyi lökosit sayısı eritrosit çökme hızı bakır fibrinojen laktik dehidrojenaz ferritin ve haptoglobin düzeylerinin tedaviye yanıtı üzerine etkisi araştırıldı Otuz sekiz hasta yaşamakta olup yedi hastada hastalık yineledi ve beş hasta öldü Ortanca izlem süresi yedi yıl dört aydı Ortalama sağkalım süresi 12 66 plusmn;0 70 yıldır En son ölüm beşinci yılda görülmüş olup; bu aydaki kümülatif sağkalım oranı 85 9 standart hata 6 1 rsquo;dir Erken evrelerde ortalama sağkalım süresi 13 10 plusmn;0 81 yıl ileri evreler için 12 56 plusmn;0 96 yıldı Çıkarımlar: Bulky hastalık ortalama sağkalım süresi için kötü seyir değişkeniydi Kadın cinsiyet bulky hastalık ve nodüler sklerozan alt tipi hastalıksız yaşam için kötü seyir etmeniydi Türk Ped Arfl 2013; 48: 310 4

Anahtar Kelimeler

• Hodgkin hastalığı, seyir, nodüler sklerozan

Kaynakça

1. Ries LA, Kosary CL, Hankey BF, et al. SEER Cancer Statistics Review 1973-1995. Bethesda, Md: National Cancer Institute, 19
2. Cavdar AO, Tacoy A, Babacan E, et al. Hodgkin’s disease in Turkish children: a clinical and histopathologic analysis. J Natl Cancer Inst 1977; 58: 479-81.
3. Büyükpamukçu M, Atahan L, Cağlar M, Kutluk T, Akyüz C, Hazar V. Hodgkin’s disease in Turkish children: clinical characteristics and treatment results of 210 patients. Pediatr Hematol Oncol 1999; 16: 119-29.
4. Nachman JB, Sposto R, Herzog P, 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. J Clin Oncol 2002; 20: 3765-71
5. Smolewski P, Robak T, Krykowski E, et al. Prognostic factors in Hodgkin’s disease: multivariate analysis of 327 patients from a single institution. Clin Cancer Res 2000; 6: 1150-60. Pötter R. Paediatric Hodgkin’s disease. Eur J Cancer 1999; 35: 1466Hudson MM, Onciu M, Donaldson SS. Hodgkin lymphoma. In: Pizzo PA, Poplack DG, (eds). Principles and practice of pediatric oncology. 5th edition. Philadelphia: Lippincott Williams&Wilkins, 2005: 694-721.
6. Oguz A, Karadeniz C, Okur FV, et al. Prognostic factors and treatment outcome in childhood Hodgkin disease. Pediatr Blood Cancer 2005; 45: 670-5.
7. Josting A, Rueffer U, Franklin J, Sieber M, Diehl V, Engert A. Prognostic factors and treatment outcome in primary progressive Hodgkin lymphoma: a report from the German Hodgkin Lymphoma Study Group. Blood 2000; 96: 1280-6.
8. Celkan T, Barış S, Özkan A, ve ark. Çocukluk çağı Hodgkin hastalığının seyri ile hematolojik ve diğer değişkenlerin ilişkisi Türk Ped Arş 2008; 43: 46-9.

9. García R, Hernández JM, Caballero MD, et al. Serum lactate dehydrogenase level as a prognostic factor in Hodgkin’s disease. Br J Cancer 1993; 68: 1227-31.
10. Glimelius I, Molin D, Amini RM, Gustavsson A, Glimelius B, Enblad G . Bulky disease is the most important prognostic factor in Hodgkin lymphoma stage IIB. Eur J Haematol 2003; 71: 327-33. Pulte D, Gondos A, Brenner H. Trends in 5- and 10-year survival after diagnosis with childhood hematologic malignancies in the United States, 1990-2004. J Natl Cancer Inst 2008; 100: 1301Yörük ve ark.
11. Hodgkin hastalığında prognostik etmenler / Hodgkin’s disease prognostic factors