title: [The incidence and treatment of the first relapse in children with Hodgkin's disease].
abstract: From January 1988, to December 1997, among 447 children with Hodgkin's disease (HD) who underwent initial treatment in seven centres of the Polish Paediatric Leukaemia/Lymphoma Study Group, 442 patients obtained a complete remission (CR). The initial treatment consisted of multidrug chemotherapy (B-DOPA and MVPP) combined with local radiotherapy. Relapses occurred in 35 cases (7,9%). Two patients from other centres were also included in this analysis. Four patients were lost to follow-up; 33 patients with relapses were analysed. Early relapses (first complete remission (CR) shorter than 12 months) occurred in 17 cases. Treatment of the first relapse consisted of different types of multidrug chemotherapy. Six patients underwent high-dose chemotherapy and peripheral blood stem cells transplantation. Radiotherapy was used in 19 children. Second CR was achieved in 28 patients (85%). In 10 children (36%) second relapse occurred after 4 to 21 months (median = 10). In 17 cases the second CR lasted 12-14 (median=54) months. The probability of the 7-year freedom from second relapse was 64%. Eleven patients died; one of them in second CR due to toxic liver damage. Results of treatment in children with early relapses were significantly worse. In 17 patients with early relapse, and 16 children with late relapse, the second CR was achieved in 70% and 100% of cases, respectively. The probability of the 7-year overall survival, freedom from second relapse and event-free survival in children with early and late relapse was: 42, 58, 40%, and 94, 69, and 66%, respectively. The therapeutic results in the subgroups of children with relapses treated with different methods were not comparable because of the small number of children in each group. The use of multidrug chemotherapy with or without radiotherapy allows to achieve a long lasting second CR in more than 50% of children with HD who relapsed after initial combined modality treatment. The optimal treatment of relapsed HD in patients initially treated with multidrug chemotherapy with or without of radiotherapy, is currently unknown.
authors.affiliation: Klinika Onkologii, i Hematologii Dzieciecej, PA Instytut Pediatrii, Wydzial Lekarski UJ, 30-663 Kraków, ul. Wielicka 265, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Balwierz
authors.forename: A
authors.initials: A
authors.lastname: Moryl-Bujakowska
authors.forename: J
authors.initials: J
authors.lastname: Bogusławska-Jaworska
authors.forename: J
authors.initials: J
authors.lastname: Pisarek
authors.forename: M
authors.initials: M
authors.lastname: Raś
authors.forename: D
authors.initials: D
authors.lastname: Sońta-Jakimczyk
authors.forename: A
authors.initials: A
authors.lastname: Janik-Moszant
authors.forename: R
authors.initials: R
authors.lastname: Rokicka-Milewska
authors.forename: B
authors.initials: B
authors.lastname: Sopylo
authors.forename: B
authors.initials: B
authors.lastname: Kolakowska-Mrozowska
authors.forename: P
authors.initials: P
authors.lastname: Kołecki
authors.forename: M
authors.initials: M
authors.lastname: Kaczmarek-Kanold
authors.forename: J
authors.initials: J
authors.lastname: Kowalczyk
authors.forename: T
authors.initials: T
authors.lastname: Odój
authors.forename: M
authors.initials: M
authors.lastname: Matysiak
authors.forename: T
authors.initials: T
authors.lastname: Newecka-Samól
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000453:epidemiology* / Q000532:radiotherapy*; D006801:Humans; D015994:Incidence; D008297:Male; D011044:Poland / Q000453:epidemiology; D012008:Recurrence; D012074:Remission Induction; D016019:Survival Analysis; D013997:Time Factors