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Hodgkin's disease in childhood: therapy results in Argentina
Insights
Childhood Hodgkin's disease survival significantly improved from 1940-1977 due to combined chemotherapy. The CCVPP regimen did not enhance remission or survival rates compared to CVPP in pediatric Hodgkin's disease.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Background:
- Hodgkin's disease is a cancer of the lymphatic system.
- Treatment for childhood Hodgkin's disease has evolved significantly over time.
- Historical data on treatment outcomes in pediatric Hodgkin's disease is crucial for understanding progress.
Purpose of the Study:
- To analyze the survival trends of childhood Hodgkin's disease in Argentina from 1940 to 1977.
- To evaluate the impact of evolving diagnostic and therapeutic strategies on patient outcomes.
- To assess the efficacy of different chemotherapy regimens, including CVPP and CCVPP.
Main Methods:
- Retrospective analysis of 152 pediatric patients (≤15 years) diagnosed with Hodgkin's disease between 1940 and 1977.
- Patients were categorized into three treatment periods: 1940-1966, 1967-1972, and 1973-1977.
- Treatment involved radiation therapy followed by cyclophosphamide-vinblastine-procarbazine-prednisone (CVPP) chemotherapy, with or without CCNU (CCVPP) in a randomized trial.
Main Results:
- Crude 6-year survival rates improved across the periods: 34% (1940-1966), 50% (1967-1972), and 79% (1973-1977).
- The combination chemotherapy regimen CCVPP did not show improved complete remission rates or prolonged relapse-survival compared to CVPP.
- Multidrug chemotherapy alone demonstrated successful management across all stages of childhood Hodgkin's disease.
Conclusions:
- Significant improvements in childhood Hodgkin's disease survival are linked to combined multidrug chemotherapy within clinical trials.
- The CCVPP regimen offers no additional benefit over CVPP for pediatric Hodgkin's disease.
- Chemotherapy alone is an effective treatment strategy for all stages of childhood Hodgkin's disease.
Abstract:
From 1940 to 1977, a total of 152 children aged 15 years or less with the histologic diagnosis of Hodgkin's disease were treated in Argentina. For analysis, these patients were placed into three periods which displayed the most outstanding changes in diagnostic workup and therapy. The periods are as follows: (1) 1940 to 1966 (43 children), (2) 1967 to 1972 (35 children), and (3) 1973 to 1977 (74 children). The patients were treated with extended field radiation therapy and followed by courses of cyclophosphamide-vinblastine-procarbazine-prednisone, with CCNU added (CCVPP) or not added (CVPP) in a randomized trial. The mean age of the whole group was 7.5 years (range 2 to 15 years) and there was a predominance of males (79%). Crude 6-year survival for the three periods were as follows: 1940 to 1966, 34%; 1967 to 1972, 50%; and 1973 to 1977, 79%. We conclude that (1) survival of Hodgkin's disease of childhood has shown a rather marked improvement during the last decade and this progress is probably due to the use of combined multidrug chemotherapy administered under collaborative controlled clinical trials; (2) preliminary evaluation of the results of CVPP and CCVPP therapy shows that the latter combination (CCVPP) neither increases the percent of patients achieving complete remission nor prolongs relapse-survival in Hodgkin's disease of childhood: and (3) all stages of childhood Hodgkin's disease can be successfully managed with multidrug chemotherapy alone.
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