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Childhood Hodgkin's disease in Campinas, Brazil
S L Faria1, J Vassallo, J M Cosset
1Centro de Investigações Hematológicas Dr. Domingos Boldrini, State University of Campinas, UNICAMP, Brazil.
Insights
This study on pediatric Hodgkin's disease in Brazil found similar histology to developed nations but worse outcomes. Further research is needed to understand the reasons for this disparity in pediatric Hodgkin's disease survival.
Area of Science:
- Pediatric Oncology
- Epidemiology
- Hematology
Background:
- Limited clinical data exists for pediatric Hodgkin's disease in low-income countries.
- This study aims to clarify the geographic distribution and clinical characteristics of pediatric Hodgkin's disease in Brazil.
Purpose of the Study:
- To evaluate clinical data of pediatric Hodgkin's disease patients in Campinas, Brazil.
- To contribute to the understanding of Hodgkin's disease in developing nations.
Main Methods:
- Retrospective analysis of 37 pediatric patients (under 17) with biopsy-proven Hodgkin's disease (HD) from 1978-1988.
- Histological review using the Rye classification system; staging included exploratory laparotomy for most.
- Treatment was individualized, later adopting a German protocol.
Main Results:
- Nodular sclerosis (19), mixed cellularity (14), and lymphocyte-depleted (3) subtypes observed.
- Mean age 7 years, male/female ratio 2:1; 50% in advanced stages III/IV.
- Five-year survival was 78%; 5% developed secondary acute myeloid leukemia.
Conclusions:
- Histological subtype distribution and advanced stage prevalence are similar to developed countries.
- Pediatric Hodgkin's disease patients in this Brazilian cohort had poorer outcomes.
- The cause of worse outcomes is unclear and not apparently related to histological subtypes.
Purpose:
Little clinical information about Hodgkin's disease in children is available from poor countries. The object of this study is to evaluate our data in Campinas, Brazil and hope "to make one dot on the geographic map of this disease more clear."
Patients And Methods:
Between 1978 and 1988, 46 patients under the age of 17 years with biopsy-proven Hodgkin's Disease (HD) were referred for evaluation at Centro Boldrini in Campinas, São Paulo state, in Brazil. Thirty-seven of them were treated and followed-up only at this Center and are the subjects of this analysis. All the original histological slides were obtained, reviewed, and classified according to the Rye system. Staging procedures included exploratory laparotomy in 33 of 37 children, but none had lymphangiography. Treatment was individualized until January 1986 when the German protocol was adopted.
Results:
Nineteen cases were classified as nodular sclerosis, 14 as mixed cellularity, and three as lymphocyte depleted. Mean age was 7 years; male/female ratio was 2:1. Fifty percent were advanced stages III and IV and 46% (17/37) had at least one of the systemic B symptoms. Mean follow-up was 81 months (range from 41 to 174 months). Five-year actuarial overall survival was 78%. Two children (5%) had acute myeloid leukemia at 25 and 49 months after diagnosis.
Conclusions:
Although distribution of histological subtypes of our cases is similar to other reports in developed countries, as well as percentage of advanced stages III/IV, our patients fared worse when compared to those reports. The reason for this continues to remain unclear but it does not seem to be related to histology subtypes.