Annika Englund1, Ingrid Glimelius2,3, Klaus Rostgaard4, Karin E Smedby2,5, Sandra Eloranta2, Daniel Molin3, Thomas Kuusk1, Peter de Nully Brown6, Peter Kamper7, Henrik Hjalgrim4,6, Gustaf Ljungman1, Lisa Lyngsie Hjalgrim4,8. 1. a Pediatric Oncology Unit, Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden. 2. b Clinical Epidemiology Unit, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden. 3. c Experimental and Clinical Oncology Unit, Department of Immunology, Genetics and Pathology , Uppsala University , Uppsala , Sweden. 4. d Department of Epidemiology Research , Statens Serum Institut , Copenhagen , Denmark. 5. e Hematology Center , Karolinska University Hospital , Stockholm , Sweden. 6. f Department of Haematology , Rigshospitalet , Copenhagen , Denmark. 7. g Department of Haematology , Aarhus University Hospital , Aarhus C , Denmark. 8. h Department of Paediatrics and Adolescent Medicine , Rigshospitalet , Copenhagen , Denmark.
Abstract
BACKGROUND: Hodgkin lymphoma (HL) treatment protocols for children, adolescents and young adults traditionally differ, but the biological and clinical justification for this remains uncertain. MATERIAL AND METHODS: We compared age-dependent clinical presentation and treatment and outcome for 1072 classical HL patients 0-24 years diagnosed in Denmark (1990-2010) and Sweden (1992-2009) in pediatric (n = 315, Denmark <15 years, Sweden <18 years) or adult departments (n = 757). Distribution of clinical characteristics was assessed with Pearson's chi2-test and Mantel-Haenszel trend test. The Kaplan-Meier method was used for survival analyses. Hazard ratios (HR) were used to compare the different treatment groups and calculated using Cox regression. RESULTS: Children (0-9 years) less often presented with advanced disease than adolescents (10-17 years) and young adults (18-24 years) (stage IIB-IV: children 32% vs. adolescents 50%, and adults 55%; p < .005). No variation in overall survival (OS) was seen between pediatric and adult departments or by country. Danish pediatric patients received radiotherapy (36%) less frequently than Swedish pediatric patients (71%) (p < .0001). Ten-year event-free survival (EFS) was lower among Danish pediatric patients (0-14 years) (0.79; 95% confidence interval (CI) 0.70-0.86) than among Swedish pediatric patients (0-17 years) (0.88; 95% CI 0.83-0.92), HR (1.93; 95% CI 1.08-3.46). A similar pattern was seen between adult patients in the two countries: Denmark 10-year EFS 0.85 (95% CI 0.81-0.88), Sweden 0.88 (95% CI 0.84-0.91), adjusted HR 1.51 (95% CI 1.03-2.22). CONCLUSION: Adolescents and young adults shared similar clinical presentation suggesting a rationale of harmonized treatment for these groups. Both adult and pediatric protocols provided high OS with no significant difference between the departments. The less frequent use of radiotherapy in Danish pediatric patients corresponded to a lower EFS, but comparable OS in all groups confirmed effective rescue strategies for the relapsing patients.
BACKGROUND:Hodgkin lymphoma (HL) treatment protocols for children, adolescents and young adults traditionally differ, but the biological and clinical justification for this remains uncertain. MATERIAL AND METHODS: We compared age-dependent clinical presentation and treatment and outcome for 1072 classical HL patients 0-24 years diagnosed in Denmark (1990-2010) and Sweden (1992-2009) in pediatric (n = 315, Denmark <15 years, Sweden <18 years) or adult departments (n = 757). Distribution of clinical characteristics was assessed with Pearson's chi2-test and Mantel-Haenszel trend test. The Kaplan-Meier method was used for survival analyses. Hazard ratios (HR) were used to compare the different treatment groups and calculated using Cox regression. RESULTS:Children (0-9 years) less often presented with advanced disease than adolescents (10-17 years) and young adults (18-24 years) (stage IIB-IV: children 32% vs. adolescents 50%, and adults 55%; p < .005). No variation in overall survival (OS) was seen between pediatric and adult departments or by country. Danish pediatric patients received radiotherapy (36%) less frequently than Swedish pediatric patients (71%) (p < .0001). Ten-year event-free survival (EFS) was lower among Danish pediatric patients (0-14 years) (0.79; 95% confidence interval (CI) 0.70-0.86) than among Swedish pediatric patients (0-17 years) (0.88; 95% CI 0.83-0.92), HR (1.93; 95% CI 1.08-3.46). A similar pattern was seen between adult patients in the two countries: Denmark 10-year EFS 0.85 (95% CI 0.81-0.88), Sweden 0.88 (95% CI 0.84-0.91), adjusted HR 1.51 (95% CI 1.03-2.22). CONCLUSION: Adolescents and young adults shared similar clinical presentation suggesting a rationale of harmonized treatment for these groups. Both adult and pediatric protocols provided high OS with no significant difference between the departments. The less frequent use of radiotherapy in Danish pediatric patients corresponded to a lower EFS, but comparable OS in all groups confirmed effective rescue strategies for the relapsing patients.
Authors: Ingrid Glimelius; Annika Englund; Klaus Rostgaard; Karin E Smedby; Sandra Eloranta; Peter de Nully Brown; Christoffer Johansen; Peter Kamper; Gustaf Ljungman; Lisa Lyngsie Hjalgrim; Henrik Hjalgrim Journal: Cancer Med Date: 2019-07-02 Impact factor: 4.452
Authors: Jae Min Lee; Jung Yoon Choi; Kyung Taek Hong; Hyoung Jin Kang; Hee Young Shin; Hee Jo Baek; Hoon Kook; Seongkoo Kim; Jae Wook Lee; Nack Gyun Chung; Bin Cho; Seok Goo Cho; Kyung Mi Park; Eu Jeen Yang; Young Tak Lim; Jin Kyung Suh; Sung Han Kang; Hyery Kim; Kyung Nam Koh; Ho Joon Im; Jong Jin Seo; Hee Won Cho; Hee Young Ju; Ji Won Lee; Keon Hee Yoo; Ki Woong Sung; Hong Hoe Koo; Kyung Duk Park; Jeong Ok Hah; Min Kyoung Kim; Jung Woo Han; Seung Min Hahn; Chuhl Joo Lyu; Ye Jee Shim; Heung Sik Kim; Young Rok Do; Jae Won Yoo; Yeon Jung Lim; In Sang Jeon; Hee Won Chueh; Sung Yong Oh; Hyoung Soo Choi; Jun Eun Park; Jun Ah Lee; Hyeon Jin Park; Byung Kiu Park; Soon Ki Kim; Jae Young Lim; Eun Sil Park; Sang Kyu Park; Eun Jin Choi; Young Bae Choi; Jong Hyung Yoon Journal: J Korean Med Sci Date: 2020-11-30 Impact factor: 2.153