Number of involved anatomic areas as a risk predictor in pediatric Hodgkin's lymphoma: a retrospective study.
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, Ann-Arbor 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 > or = 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/> or = 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.


CONCLUSIONS
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.
Morais
Adriana
A
Oncohematology Pediatric Center, Hospital Universitário Oswaldo Cruz, Recife, PE, Brazil.
Barros
Mário Henrique M
MH
Hassan
Rocio
R
Morais
Vera L L
VL
Muniz
Maria Tereza C
MT
D000293:Adolescent; D000367:Age Factors; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D004700:Endocrine System Diseases / Q000139:chemically induced / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin