Prognostic factors for children with Hodgkin's disease treated with combined-modality therapy.

Abstract

PURPOSE:

Evaluation of pretreatment factors to identify children at high risk for relapse after combined-modality therapy for Hodgkin's disease.

PATIENTS AND METHODS:

From 1990 to 2000, 328 pediatric patients with clinical stage I to IV Hodgkin's disease were treated with chemotherapy and low-dose involved-field radiotherapy on prospective, collaborative, risk-adapted protocols at three institutions. Pretreatment factors were analyzed by univariate and multivariate analysis for prognostic significance for 5-year disease-free survival (DFS) and overall survival (OS).

RESULTS:

With a median follow-up of 59 months (range, 8 to 125 months), the 5-year DFS and OS for all patients were 83% and 93%, respectively. Several factors were associated with inferior DFS and OS by univariate analysis. By multivariate analysis, male sex; stage IIB, IIIB, or IV disease; bulky mediastinal disease; WBC more than 13.5 x 10(3)/mm3; and hemoglobin less than 11.0 g/dL were significant for inferior DFS. A prognostic index was developed incorporating the five significant factors from the multivariate analysis, assigning each a score of 1. The 5-year DFS and OS for children with a prognostic score of 0 to 1 were 94% and 99%; score 2, 85% and 96%; score 3, 71% and 92%; and score 4 or 5, 49% and 72%, respectively. There was a significant difference in DFS among each of these groups, with significantly worse OS in those with a score of 4 to 5.

CONCLUSION:

A prognostic index that was based on five pretreatment factors correlated with inferior DFS by multivariate analysis stratified patients by outcome; this may be useful in assigning children with Hodgkin's disease to risk-adapted therapy.

• Authors: Ron S Smith, Qing Chen, Melissa M Hudson, Michael P Link, Larry Kun, Howard Weinstein, Amy Billett, Karen J Marcus, Nancy J Tarbell, Sarah S Donaldson
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 21 Issue 10 Pg. 2026-33 (May 15 2003) ISSN: 0732-183X [Print] United States
• PMID: 12743158 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Combined Modality Therapy
• Disease-Free Survival
• Female
• Hodgkin Disease (mortality, pathology, therapy)
• Humans
• Logistic Models
• Male
• Multicenter Studies as Topic
• Neoadjuvant Therapy
• Neoplasm Recurrence, Local (mortality, pathology, therapy)
• Neoplasm Staging
• Prognosis
• Prospective Studies
• Survival Analysis
• United States