Pediatric hodgkin's disease in costa rica: Twelve years' experience of primary treatment by chemotherapy alone, without staging laparotomy

Abstract

This is a prospective and nonrandomized study in which 86 children with previously untreated Hodgkin's disease (HD) were clinically staged (CS) and treated with chemotherapy (CT) alone. Fifty-two (CS IA-38, IIA-7, IIB-3, IIIA-4) received six courses of cyclophosphamide, vinblastine, procarbazine, and prednisone (CVPP). Ten (CS IA with peripheral nodes) received only three courses of CVPP with a reinforcement of C on day 8. Twenty-four (CS IIIB-18, IVA-2, IVB-4) received six courses of CVPP alternating with six courses of epirubicin, bleomycin, and vincristine (EBO). Surgical staging was not performed in any patient. Two patients (CS IIIB) had partial remission and died from progressive disease. Seventy out of 86 children have not relapsed and are in complete remission with a median follow-up of 65 months (range 13-156 months); 14 children relapsed seven to 37 months from diagnosis (median 16 months); one of them (IV B) died of disease. Thirteen are in second and third remission (median 55 months). Actuarial five year survival rates and relapse-free survival rates are 100% and 90% for CS I to IIIA and 81% and 60% for CS IIIB and IV, respectively. As a result of this study, we can conclude that in developing countries most of the children with HD staged by noninvasive diagnostic techniques can be cured with CT alone as primary treatment and thus will not suffer from the late effects of radiotherapy (RT) and the morbidity of laparotomy and splenectomy. RT alone or with other CT combinations should be considered for children who develop relapse of HD.

Treatment of Hodgkin's disease in children with alternating mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) courses without radiotherapy

“…However, when a relapse occurs, the outcome, as based on our two observations, is poor. The decrease in DFS in patients with more advanced stage HD treated without radiotherapy as reported by Lobo-Sanahuja et al [16] using CVPP (cyclophosphamide, vinblastine, procarbazine, prednisone)/ EBO (epirubicin, bleomycin, and vincristine) has not been seen in our patients, but as only one of our patients was CS IV, we cannot make a conclusion for this category of patients. In our study to date only one child with initially CS I and another child with CS II have relapsed.…”

“…Sackman-Muriel et al [23] concluded from a randomized study that comparable results can be achieved using chemotherapy with or without radiotherapy. Recently, Lobo-Sanahuja et al [16] reported on 86 children with DFS rates of 90% and 60% for CS I-IIIA and CS IIIB-IV, treated with chemotherapy only. In most studies, however, only a few CS IV patients have been included.…”

Childhood stage IV Hodgkin disease: Therapeutic results of the Polish Pediatric Leukemia/Lymphoma Study Group

“…In this stage, systemic symptoms are noted in some 65-80% of patients [21,26,28,30]. Among 783 of our patients with HD, stage IV was diagnosed in 57 children (7.3%).…”

“…In our material (Table I), in the years 1971-1982, hepatic involvement was predominant (41-43%), followed by lung involvement (50%), but differences were not significant. Reports from Costa Rica [26], Turkey [29], and Italy [21] describe lymphocyte depletion type in patients with stage IV HD occurring in 66.7%, 26%, and 10%, respectively. On the other hand, pediatric population data compiled in the United States show no lymphocyte depletion type in any HD stage [30].…”

“…Stage IV HD is diagnosed in children in 9-31,8% of cases [14,19,21,[26][27][28][29]. In this stage, systemic symptoms are noted in some 65-80% of patients [21,26,28,30].…”