Hodgkin lymphoma in children, adolescents and young adults – a comparative study of clinical presentation and treatment outcome

Abstract

Background: Hodgkin lymphoma (HL) treatment protocols for children, adolescents and young adults traditionally differ, but the biological and clinical justification for this remains uncertain. Material and methods: We compared age-dependent clinical presentation and treatment and outcome for 1072 classical HL patients 0-24 years diagnosed in Denmark (1990Denmark ( -2010 and Sweden (1992Sweden ( -2009 in pediatric (n ¼ 315, Denmark <15 years, Sweden <18 years) or adult departments (n ¼ 757). Distribution of clinical characteristics was assessed with Pearson's chi 2 -test and Mantel-Haenszel trend test. The Kaplan-Meier method was used for survival analyses. Hazard ratios (HR) were used to compare the different treatment groups and calculated using Cox regression. Results: Children (0-9 years) less often presented with advanced disease than adolescents (10-17 years) and young adults (18-24 years) (stage IIB-IV: children 32% vs. adolescents 50%, and adults 55%; p < .005). No variation in overall survival (OS) was seen between pediatric and adult departments or by country. Danish pediatric patients received radiotherapy (36%) less frequently than Swedish pediatric patients (71%) (p < .0001). Ten-year event-free survival (EFS) was lower among Danish pediatric patients (0-14 years) (0.79; 95% confidence interval (CI) 0.70-0.86) than among Swedish pediatric patients (0-17 years) (0.88; 95% CI 0.83-0.92), HR (1.93; 95% CI 1.08-3.46). A similar pattern was seen between adult patients in the two countries: Denmark 10-year EFS 0.85 (95% CI 0.81-0.88), Sweden 0.88 (95% CI 0.84-0.91), adjusted HR 1.51 (95% CI 1.03-2.22). Conclusion: Adolescents and young adults shared similar clinical presentation suggesting a rationale of harmonized treatment for these groups. Both adult and pediatric protocols provided high OS with no significant difference between the departments. The less frequent use of radiotherapy in Danish pediatric patients corresponded to a lower EFS, but comparable OS in all groups confirmed effective rescue strategies for the relapsing patients.

Distribution of hospital care among pediatric and young adult Hodgkin lymphoma survivors—A population‐based cohort study from Sweden and Denmark

“…The present investigation was also inspired by differences in HL treatment dictated by administrative and geographical circumstances, with Swedish children receiving more radiotherapy than Danish children . Interestingly, however, we saw little evidence that these differences were reflected in differences in admissions to inpatient and specialist outpatient care during our follow‐up span.…”

“…Our study cohort has been described previously. 2,17,18 Briefly, through hospital file review and population-based hospital-, cancer-, and lymphoma registers we identified all individuals diagnosed with HL before the age of 25 years in the period 1992-2009 in Sweden and 1990-2010 in Denmark. Available data included information on nationality, gender, date of birth and diagnosis, Ann Arbor disease stage at diagnosis, primary treatment and outcome, and when present and relevant, relapse treatment, and outcome.…”

“…At the same time, radiotherapy has historically been more common in young Swedish HL patients compared to Danish HL patients, adding another dimension to treatment variation. 17 To advance the understanding of HL survivor morbidity, we assessed use of out-and inpatient care in a populationbased contemporarily treated cohort of children, adolescents, and young adults diagnosed with HL in Denmark and Sweden with detailed information on treatment and relapse and contrasted with a matched sample of general population comparators.…”

Results of GPOH-HD-2003 study in treatment of Hodgkin’s lymphoma in children and adolescents in the Morozovskaya Children’s Clinical Hospital

“…ЛХ у детей является тем онкологическим заболеванием, которое потенциально излечимо у абсолютного большинства пациентов и характеризуется благоприятным прогнозом. После окончания программной терапии показатели общей выживаемости (ОВ) достигают 90 % [6].…”

“…Рекомендации GPOH-HD-2003 основаны на предшествующих 6 терапевтических исследованиях DAL/GPOH, которые проводились рабочей группой в Германии с 1978 г. Их целями являлись оптимизация подходов к терапии и разработка стандартов лечения классической ЛХ у детей [6,7]. Стоит отметить, что пациенты с вариантом нодулярного лимфоидного преобладания ЛХ (НЛПЛХ) получают терапию согласно рекомендациям EuroNet-Pediatric Hodgkin's Lymphoma Group -проведение ПХТ курсами CVP (циклофосфан, винбластин, преднизолон) [8].…”