engleski

Management of pediatric Hodgkin lymphoma in Croatia

Introduction: In the past decade, considerable modifications in the managemant of Hodgkin’s disease in children have resulted in a continuously rising rate of recovery. As the disease responds favourably to the use of cytostatic therapy and radiotherapy, attempts have been made to treat as many affected children as possible with the least possible rate of early and late side effects. Previous therapy is known to have been associated with the development of secondary malignancies in some of the successfully treated children. The aim of the study was to describe the experience in the management of children with Hodgkin’s lymphoma in Croatia, staged and treated at a single institution. Patients and Methods: During the 1990–2011 period, 75 children with Hodgkin’s lymphoma (39 male and 36 female) were treated at the Department of Hematology and Oncology, University Department of Pediatrics, University Hospital Centre Medical Faculty Zagreb, Croatia. The patients were administered a combination of cytostatic therapy (OPPA, OEPA and COPP) and radiotherapy (involved field radiation). Patients were allocated to three treatment groups (TG) by disease stage: TG1, stages I and IIA ; TG2, stages IIEA, IIB and IIIA ; and TG3, stages IIEB, IIIB, IIIE and IV. All patients underwent initially two cycles of OPPA or OEPA. In TG1, no further chemotherapy was given ; patients in TG2 and TG3 received additional two or four cycles of COPP. The distribution of the patients was as follows: TG1, 27 = 36% ; TG2, 28 = 37.3% ; and TG3, 20 =26.7%. Radiotherapy was administered to the initially involved sites. Standard dosage was 20Gy. Results: Remission was achieved in all patients ; in six patients with relapse of the disease, highly aggressive cytostatic therapy and radiotherapy were introduced, in four of them in combination with autologous bone marrow transplantation ; three patients died. Seventy-two patients are still alive in the first or the second remission. There were no severe side effects and no case of secondary malignancies in any patients. Conclusion: Combined modality therapy using risk-adapted low dose, involved radiotherapy + chemotherapy is an optimal treatment for the majority of children with Hodgkin’s lymphoma.

Hodgkin lymphoma; children; treatment

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