[Influence of age on treatment results in children and adolescents with Hodgkin's disease].
Over the last few years, treatment failures (progression, relapse) in Hodgkin's disease (HD) occurred mainly in elder children treated in the Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG) participating centers. That is why analysis of the influence of age on the treatment outcome in children and adolescents treated with the protocol introduced in 1997 was performed. In years 1997-2001, in 10 centers of PPLLSG, 280 patients (age 2.3-18.8 years) were treated for HD. In all patients MVPP and B-DOPA chemotherapy with or without radiotherapy was introduced. Among 280 treated children the first remission was achieved in 275 patients (98.2%). Relapses occurred in 11 patients (4%). The 5-year probability of overall survival, relapse-free survival (RFS) and event-free survival (EFS) was 99%, 93% and 90%, respectively. All children with relapse were over 10 years old at the time of diagnosis (range: 10.6-17.1, median 14.6 years); mediastinal tumor mass was present in all of them. The logistic regression analysis did not reveal the border value for increasing the probability of relapse or event, thus age of 10 years (age of the youngest child with relapse) was identified as the border value. The probability of 5-year EFS and RFS for children over and under the 10th year of age was 98%, 92% and 100%, 92%, respectively. The differences were not statistically significant. Among children over the 10th year of age some features of the disease occurred more frequently: female sex, shorter history of the disease, presence of mediastinal tumor, greater stage of the disease, NS histopathological type of the disease, presence of general signs and ESR over 50 mm, greater tumor burden and higher number of involved lymphatic regions. Among the patients over the 10th year of age, the presence of the general signs and mediastinal tumor influenced the occurrence of relapses substantially. The aim of the further treatment modifications ought to comprise the need of better treatment outcome, especially in patients over the 10th years of age in which unfavorable prognostic factors are identified. child with relapse) was identified as the border value. The probability of 5-year EFS and RFS for children over and under the 10th year of age was 98%, 92% and 100%, 92%, respectively. The differences were not statistically significant. Among children over the 10th year of age some features of the disease occurred more frequently: female sex, shorter history of the disease, presence of mediastinal tumor, greater stage of the disease, NS histopathological type of the disease, presence of general signs and ESR over 50 mm, greater tumor burden and higher number of involved lymphatic regions. Among the patients over the 10th year of age, the presence of the general signs and mediastinal tumor influenced the occurrence of relapses substantially. The aim of the further treatment modifications ought to comprise the need of better treatment outcome, especially in patients over the 10th years of age in which unfavorable prognostic factors are identified.
Balwierz
Walentyna
W
Klinika Onkologii i Hematologii Dzieciecej, Polsko-Amerykańskiego Instytutu Pediatrii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. balwierz@mp.pl
Moryl-Bujakowska
Angelina
A
Depowska
Teresa
T
Klekawka
Tomasz
T
Stanuch
Helena
H
Matysiak
Michał
M
Sopyło
Barbara
B
Kołakowska-Mrozowska
Beatrycze
B
Krenke
Katarzyna
K
Chybicka
Alicja
A
Raś
Małgorzata
M
Sońta-Jakimczyk
Danuta
D
Moszant
Anna
A
Wachowiak
Jacek
J
Kaczmarek-Kanold
Małgorzata
M
Kowalczyk
Jerzy
J
Odój
Teresa
T
Balcerska
Anna
A
Drozyńska
Elzbieta
E
Wysocki
Mariusz
M
Kołtan
Andrzej
A
Krawczuk-Rybak
Maryna
M
Stolarska
Małgorzata
M
D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003606:Dacarbazine / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015337:Multicenter Studies as Topic; D011044:Poland / Q000453:epidemiology; D011241:Prednisone / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014750:Vincristine / Q000008:administration & dosage
D001761:Bleomycin; D014750:Vincristine; D003606:Dacarbazine; D004317:Doxorubicin; D011241:Prednisone