Number of involved anatomic areas as a risk predictor in pediatric Hodgkin’s lymphoma: a retrospective study

Abstract

Objective: To determine if the number of involved anatomic areas can modify the standard risk groups in pediatric Hodgkin's lymphoma, identifying children who would benefit from a reduction in treatment intensity. Methods:Retrospective study evaluating age, sex, histology, AnnArbor stage, presence of B symptoms, number of involved anatomic areas, risk grouping (favorable vs. unfavorable), and laboratory exams. All patients received doxorubicin-containing chemotherapy. Patients in complete remission for 5 years or longer were evaluated as for late effects.Results: Sixty-nine patients (2-18 years) were included, 68% belonged to the unfavorable risk group. Overall survival and event-free survival were 94 and 87%, respectively. Late effects were screened in 46 cases. Advanced stage and ≥ four involved anatomic areas had negative impact on event-free survival, while only the number of involved anatomic areas retained statistical significance when using Cox analysis (hazard ratio = 6.4, 95%CI = 1.08-38.33; p = 0.04). Risk groups were adjusted by number of involved anatomic areas (< four/≥ four involved anatomic areas), with a significant reallocation of patients (p = 0.008). Of the 30 patients with late effects, 21 were in the original unfavorable risk group and 14 (66.6%) could have been reallocated to the favorable risk group based on the number of involved anatomic areas. Conclusion:If re-stratification had been applied, a considerable number of children would have received less intensive treatment and, consequently, could have had lower chances of late effects. A prospective study could define if adjustment of risk group by number of involved anatomic areas would have any impact on survival rates. J Pediatr (Rio J). 2009;85(3):236-242:Hodgkin's lymphoma, childhood, risk groups, involved anatomic areas, late effects. ResumoObjetivo: Determinar se o número de áreas anatômicas envolvidas pode modificar os grupos de risco padrão no linfoma de Hodgkin pediátrico, identificando as crianças que poderiam se beneficiar de uma redução da intensidade do tratamento.Métodos: Estudo retrospectivo com avaliação de idade, sexo, histologia, classificação de Ann-Arbor, presença de sintomas B, número de áreas anatômicas envolvidas, grupos de risco (favorável versus desfavorável) e exames laboratoriais. Todos os pacientes receberam quimioterapia com doxorrubicina. Os pacientes em remissão completa por 5 anos ou mais foram avaliados para a detecção de efeitos tardios.Resultados: Sessenta e nove pacientes (2-18 anos) foram incluídos, sendo que 68% pertenciam ao grupo de risco desfavorável. A sobrevida global e a sobrevida livre de eventos foram de 94 e 87%, respectivamente. Os efeitos tardios foram detectados em 46 casos. Estágio avançado e ≥ quatro áreas anatômicas envolvidas tiveram impacto negativo sobre a sobrevida livre de eventos, enquanto que o número de áreas anatô-micas envolvidas apresentou significância estatística de acordo com a análise de Cox (razão de risco = 6,4; IC95% = 1,08-38,33; p = 0,04). Os grupos de risco...

3′ untranslated region A>C (rs3212227) polymorphism of Interleukin 12B gene as a potential risk factor for Hodgkin’s lymphoma in Brazilian children and adolescents

“…6,46,47 Vassilakopoulos et al 48 observed that 32% of the patients with HL had an IAA number greater than or equal to five. Another study conducted by Morais et al 45 found that 24.6% of pediatric patients with HL with more than five IAA, while 75.4% had less than five IAA. The findings found in these studies corroborate our results.…”

“…Most HL treatment protocols consider stages I, IIA, and IIIA as a favorable risk group, and the others as an unfavorable prognosis. 44 Morais et al 45 studied 69 pediatric HL patients and found that 31.9% were in the favorable disease group and 68.1% were in the unfavorable group. Similar results were observed in our study, in which 25.27% (23/91) of the cases presented favorable clinical stage and 74.73% (68/91) of the cases presented an unfavorable clinical stage.…”