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Treatment of Hodgkins Disease by Chemotherapy Alone in Indian Children



Treatment of Hodgkins Disease by Chemotherapy Alone in Indian Children



Blood 100(11): Abstract No 4711, November 16



PURPOSE. To assess the efficacy of chemotherapy alone, using eight alternating cycles of COPP (Cyclophosphamide, Vincristine, Procarbazine and Prednisolone) and ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) in all stages of childhood Hodgkin's disease, in order to avoid late affects of irradiation in children PATIENTS AND METHODS. Between January 1990 and February 2001, 148 previously untreated patients with histologically proven Hodgkin's disease were investigated and treated with four cycles of COPP alternating with four cycles of ABVD. RESULTS. There were 134 boys and 14 girls (M: F ratio 8:1) with a median age of 8 years (range 3 to 14). Ann Arbor staging was stage I in 27 (18.2%), II in 54 (36.5%), III in 59 (39.9%) and IV in 8 (5.4%) cases. Ninety four (63.5%) children had advanced stage disease (IIB-IV). B symptoms were present in 54.4% of cases. Mediastinal involvement was present in 68 (45.9%) cases and was bulky in 18 (12.2%) cases. Bulky lymph nodal mass (greater than 6 cm) was seen in peripheral sites in 46 (31.1%) cases and in retroperitoneal location in 6 (4.1%). Spleen and bone marrow were involved in 20 (13.5%) and 4 (2.7%) cases respectively. Other extra- lymphatic sites involved were lungs and pleura in 2 patients each. Response to treatment was evaluated 1 month after completing chemotherapy in 129 patients: complete remission was achieved in 120 (93.0%) patients, partial remission in 7 (5.4%) and progression occurred in 2 (1.6%) patients. Three other patients died on therapy from infectious cause (2 cases) and from ketamin-induced cardiac arrest while on progression (1 case). They were further included in the survival analysis. Four patients with mediastinal residual disease were given additional involved field radiotherapy. . After exclusion of 22 cases lost to follow-up, 110 patients were analyzable for survival. Five patients (4.2%) have relapsed 6 to 30 months after completing chemotherapy, and were treated with ABVD and involved field radiotherapy (20 to 25 Gy). Ten children have died and 100 are alive and disease-free with a median follow-up of 49 months (range 16 to 139 months). The 5-year overall survival and event-free survival are 92.3% and 89.8% respectively. In univariate analysis, significant adverse prognostic factors for event-free survival were stage IV, B symptoms, anemia and spleen involvement. CONCLUSION. Chemotherapy alone with alternating COPP/ABVD is an effective therapy in all stages of childhood Hodgkin's disease. Even patients with large mediastinal mass and peripheral or abdominal bulky disease obtain durable remission without additional radiotherapy, which should be reserved for the few cases not reaching complete remission after completing chemotherapy.

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