Treatment Success in a Cohort of Patients with Hodgkin Disease Treated during 1980 -1999 at the Department of Pediatric Oncology, University Hospital Motol, Prague, Czech Republic
Abstract
Background: The treatment strategy of Hodgkin Disease (HD) in children differs from that in adults. The goals of therapy are to optimize overall survival (OS) as well as event-free survival (ES). Maintaining a good quality of life with minimal long-term sequelae is desirable. Study Design: Our study retrospectively evaluated the success of therapy and the incidence of serious late complications in a cohort of 347 patients with HD up to 19 years of age at the time of diagnosis. All patients receiving primary treatment for HD at our hospital between 1980 and 1999 were evaluated. All patients were treated with one of the following five protocols:
1. CVPP,
2. ABVD,
3. VEPA or VAMP,
4. COPP/ABVD,
5. DBVE-PC. All patients were also treated with radiotherapy. Results: The success of the therapy was evaluated by Kaplan-Meier functions of OS and ES. Five year OS ranged from
92.7 % (SE.
3.5%) using CVPP to
96.5% (SE
3.4%) using DBVE-PC. Re-evaluation of histopathology in 40 patients with uncertain classification at the time of diagnosis found that two patients actually had Non-Hodgkin lymphoma, and thus in retrospect were treated with the wrong therapy. Adverse events included 30 deaths, including two cases of acute lymphoblastic leukemia, two cases of heart failure, and one case of cardiomyopathy. Twenty five patients died from the progression of disease. In survivors, there were 16 relapses (0.1
19.4 y after first remission) and two cases of papillocarcinoma of the thyroid (10.6 and
11.2 year after remission). Conclusions: Treatment was very successful in patients with clinical stage I and II HD using the COPP/ABVD protocol, and was comparable to the results of the multi-center "HD-90" study. The latest protocol using DBVE-PC compared to COPP/ABVD did not show better results for stages I and II as to OS and ES, but showed a non-significantly better trend for OS in stage III and IV. Our findings concur with those reported in the literature, in that the use of Ethoposide increased the risk of secondary leukemia without improving OS. Our findings, as well as a comparison of our results to those of other centers, also suggest that it may be appropriate to treat HD stage I and II in the absence of bulky disease with lower doses of radiotherapy.