Hodgkin Lymphoma in children six years Experience of Children Welfare Teaching Hospital

Abstract

Background: Hodgkin disease is characterized by progressive enlargement of lymph nodes. It is considered unicentric in origin and has predictable pattern of spread by extension to contiguous nodes. Material and Methods: Over a 6-year period, from January 1st 2003 to December 31st 2009 a retrospective study was done for 86 children with Hodgkin’s lymphoma who were admitted to the pediatric oncology unit in Children Welfare Teaching Hospital, The follow up period extended to February 10th 2011. Results: The patients were referred to from 11 governorates, 42 patients (48.8%) were from Baghdad. Highest rate of referral occurred during 2009 compared to previous years of the study. There were 63 (73.3%) males and 23(47.8%) females; male to female ratio was 2.7:1. Fifty eight patients (67.4%) presented with age group between 6-10 years, with a median age of 8 years and mean age of 7.8 years, ranged 2 years to 12.4 years. Cervical lymph node enlargement was found in 64 (74.4%) patients, followed by supraclavicular lymph node enlargement in 8 (9.3%) patients. B symptoms (weight loss, fever, and night sweating), were found in 37/80 patients (43%) The mean duration of illness was 7.5 months. Stage III was seen in 42 (48.8%) patients, followed by stage II in 33 (39.5%) patients, stage I in 10 (11.6%) patients and nil for stage IV. The commonest histopathological finding was Mixed cellularity in 71(82.6%) patients, then lymphocyte predominant in 12 (14%) patients, nodular sclerosis in 2 (2.3%) patients, and lymphocyte depleted in 1 (1.2%) patients. Seven patients were excluded from treatment outcome (4 treated with Non-Hodgkin’s Lymphoma protocol, 1 died before treatment, 1 refused treatment by the family, and 1 treated in another institute. From 79 patients who received chemotherapy; fifty six (70.9%) patients finished treatment and remained free of disease till time of last follow up, 1 (1.3%) patient died during treatment, 12 (15.2%) patients relapsed after finishing treatment, 4 (5%) patients abandoned treatment and 6 (7.6%) patients got progressive disease during treatment. At median follow up period of 36 months, ranged from 1 month – 82 months; Event free survival is 70.9%.Sevently-two (89.9%) patients were alive till time of last follow up, 2 (2.5%) died, and 5 (6.3%) lost follow up. Conclusions: Males were more commonly affected than females and age group between 6-10 years was the most common. Stage III and mixed cellularity histopathological subtype were most common. Event free and overall survival is improving, yet it is below the standard reported in other countries.