[Treatment results and prognostic significance of selected clinical and laboratory features in children diagnosed with malignant lymphoma]

Abstract

The clinical picture and results of treating malignant lymphoma in children, diagnosed and treated at the Pediatric Institute of Pomeranian Medical Academy in Szczecin during the period between May 1979 and February 1992, were analyzed. The studied group consisted of 33 children (23 boys, 10 girls) aged between 41-169 months (median 112 months, mean 110 months) having Hodgkin's lymphoma (HL), and 35 children (26 boys, 9 girls), aged between 35-171 months (median 101 months, mean 104 months), with non-Hodgkin's lymphoma (NHL). Till 1987 the children with HL were treated according to MOPP program, and since 1988 with MVPP/B-DOPA. Two children were treated according to COMP and ABVD programs. The NHL children were treated till 1985 with LSA2L2 or COAMP, and from 1986 with BFM-NHL 86 with the modification of methotrexate doses. The duration of observation involving HL cases ranged from 2 to 156 months (median 76, mean 78 months), that covering NHL cases from 3 to 153 months (median 28 months, mean 44 months). It was proved that the results of HL treatment in the Pediatric Institute of Pomeranian Medical Academy in Szczecin were comparable with the results of other centers. The probability of event free survival (EFS) for the whole group was 0.818, for children treated by MOPP program was 0.888, for children with MVPP/B-DOPA was 0.900. Unfortunately, the results of NHL treatment in our center in Szczecin are worse than those of other hematologic-oncologic institutions. The EFS was 0.550. The reason why our results were poor in treating NHL in our center was: delay in beginning the remission-inducing treatment because of diagnostic difficulties (especially in smaller hospitals): prolongation of the first remission-inducing therapy over 14 days, mainly due to generalized infection, generalized diathesis haemorrhagica with bleeding from the alimentary tract, and finally the need of modifying the treatment program BFM 86 concerning primarily the lowering of methotrexate doses from 5 g/m2 to 0.5 g/m2. That was necessary in view of our inability of monitoring the level of methotrexate in blood. All of those findings suggest the necessity of: 1) earlier proper diagnosis; the physicians taking care of children should be aware of high incidence of such neoplasms in children, especially with atypical clinical presentation; 2) full realization of the therapeutic program (particularly remission-inducing one). A general real improvement of the treatment conditions in hospitals is indispensable. The actual work has proved that in HL the detrimental prognostic factors included; the age above 10 years and histological type of nodular sclerosis. Children older than 10 years had lower EFS (1.0 vs 0.65; p < 0.05). EFS in histological type of nodular sclerosis was also lower namely (0.925 vs 0.600; p < 0.05). In the NHL group the bad prognostic factors were the age over 10 years and proliferation of T-cells. Patients older than 10 years displayed statistically lower EFS (0.709 vs 0.288; p < 0.05). The children with T-NHL had also lower EFS (0.621 vs 0.187; p < 0.05). It is necessary that the prognosis in these children should be substantially improved by elaborating treatment programme being adjusted to cope with the risk factors.