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Number of involved anatomic areas as a risk predictor in pediatric Hodgkin's lymphoma: a retrospective study
Adriana Morais1, Mário Henrique M Barros, Rocio Hassan
1Oncohematology Pediatric Center, Hospital Universitário Oswaldo Cruz, Recife, PE, Brazil.
Insights
The number of involved areas in pediatric Hodgkin's lymphoma can refine risk groups, potentially reducing treatment intensity and late effects for some children. Further studies are needed to confirm survival impacts.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Pediatric Hodgkin's lymphoma risk stratification is crucial for tailoring treatment intensity.
- Standard risk groups may not fully capture individual patient prognoses.
- Identifying children who can benefit from reduced treatment is a key clinical goal.
Purpose of the Study:
- To assess if the number of involved anatomic areas modifies standard risk groups in pediatric Hodgkin's lymphoma.
- To identify pediatric patients who might benefit from less intensive treatment protocols.
- To evaluate the impact of anatomic area involvement on event-free survival.
Main Methods:
- Retrospective analysis of 69 pediatric Hodgkin's lymphoma patients (ages 2-18).
- Evaluation of clinical factors including Ann-Arbor stage, B symptoms, and number of involved areas.
- Cox analysis used to determine the statistical significance of factors influencing event-free survival.
Main Results:
- Sixty-eight percent of patients were initially in the unfavorable risk group.
- An increased number of involved anatomic areas (> or = four) significantly impacted event-free survival (HR=6.4, p=0.04).
- Re-stratification based on involved areas led to significant patient reallocation, with 66.6% of those with late effects potentially moving to a favorable group.
Conclusions:
- Adjusting risk groups by the number of involved anatomic areas could allow for reduced treatment intensity in pediatric Hodgkin's lymphoma.
- This re-stratification may decrease the likelihood of late treatment-related effects.
- Prospective studies are warranted to validate the impact on survival rates.
Objectives:
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.