Revista Brasileira de Hematologia e Hemoterapia (Jan 2010)
Linfoma de Hodgkin na infância e adolescência: 15 anos de experiência com o protocolo DH-II-90 Hodgkin's lymphoma in children and adolescents: 15 years of experience with the DH-II-90 protocol
Abstract
O desafio do tratamento do linfoma de Hodgkin na infância reside na redução da toxicidade aguda e tardia sem afetar os bons resultados terapêuticos. Crianças e adolescentes portadores de linfoma de Hodgkin recém-diagnosticado foram tratados com o protocolo institucional DH-II-90. Os objetivo deste trabalho foram: 1)avaliar as taxas de sobrevida global (SG) e livre de eventos (SLE) do protocolo DH-II-90 aplicado a portadores de LH; 2)avaliar as taxas de SG e SLE conforme estádio, idade, tumor "bulky", massa mediastinal, sintomas B, dose de radioterapia e 3)descrever os efeitos tardios. Sessenta e oito pacientes portadores de LH recém-diagnosticado, com idade entre 0 e 21 anos (idade mediana 9 anos, 20F:48M), foram tratados com quimioterapia (baixo risco:ABVD; alto risco:ABVD+MOP/COP) e radioterapia. O estadiamento foi distribuído desta forma: nove (13,2%) estádio I A; 29 (42,6%) II A; cinco (7,4%) II B; nove (13,2%) III A; dez (14,7%) III B; dois (2,9%) IV A e quatro (5,9%) IV B. A SG em dez anos foi de 96,1% ± 3,8 para o grupo de baixo risco e 93,3% ± 4,5 para o de alto risco (p:0,402). A SLE foi de 88,9% ± 5,2 em dez anos para o de alto risco e 86,5% ± 6,3 para o de baixo risco (p: 0,969). A presença de massa mediastinal e doses de radioterapia maiores que 2100 cGy (p= 0,020 e p= 0,014, respectivamente) apresentam impacto negativo na SLE e a doença estádio I tem impacto positivo na SLE. Disfunção e carcinoma de tireoide são os efeitos tardios mais frequentes neste grupo de doentes. O protocolo DH-II-90 obteve resultados terapêuticos favoráveis, porém as taxas de complicações tardias, embora aceitáveis, demandam revisão do programa terapêutico.The challenge of new protocols for Hodgkin's lymphoma (HL) treatment is to decrease the toxicity without impairing the results. The DH-II-90 protocol was designed to treat children and adolescents with HL. The objectives of this work were: 1) to assess the overall and event free survival of patients with newly diagnosed HL treated with the DH-II-90 protocol, 2) to assess the overall and event free survival by stage, age, presence of bulky disease, mediastinal mass, B symptoms, dose and type of radiotherapy, and 3) to describe late effects, data collected from the patients' charts. Sixty-eight patients with HL, from 0 to 21 years of age (median age 9 yr, 20F:48M) were treated with ABVD and involved-field radiotherapy for low-risk patients, and ABVD plus MOP or COP and extended field radiotherapy for high-risk patients. Stage distribution was: nine (13.2%) stage I A; 29 (42.6%) II A; five (7.4%) II B; nine (13.2%) III A; ten (14.7%) III B; two (2.9%) IV A and four (5.9%) IV B. The 10-year overall survival was 96.1% ± 3.8% for the low-risk group and 93.3% ± 4.5% for the high-risk group (p= 0.402). The 10-year event free survival was 88.9% ± 5.2% for high-risk and 86.5% ± 6.3% for low-risk patients (p= 0.969). The presence of mediastinal mass and more than 2100 cGy radiation doses had negative impact on event free survival (p= 0.020 and p= 0.014, respectively).Thyroid gland dysfunction was frequently observed and there were two cases of thyroid carcinoma. The DH-II-90 protocol is effective, but, due to the late effects presented by this group of patients, further modifications of the therapy schedule are required.
