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A Clinical Study of Childhood Non-Hodgkin's Lymphoma.

Journal of the Korean Pediatric Society 1990;33(6):807-820.
Published online June 30, 1990.
A Clinical Study of Childhood Non-Hodgkin's Lymphoma.
In Sang Jeon, Hyo Seop Ahn, Chong Ku Yun
Department of Pediatircs, College of Medicine, Seoul National University Seoul, Korea
소아 non-Hodgkin 림프종에 관한 연구
전인상, 안효섭, 윤종구
서울대학교 의과대학 소아과학교실
Received: 4 January 1990   • Accepted: 27 February 1990
Abstract
To study the clinical characteristics and treatment result of childhood NHL, the retrospective study was performed on 82 children with NHL, experienced at the department of Pediatrics, Seoul National University Hospital, during 10 years from January 1979 to December 1988. The results were as follows; 1) The sex ratio of male to female was 2.4:1. 2) The age of patients ranged from 8 months to 15 years, and the median was 7.5 years. The distribution of patients by age was even. 3) Fifty-five of the 60 cases (91.6%) fell into one of three major histologic categories of diffuse lymphomas, 22 (36.7%) were lymphoblastic, 17 (28.3%) were Burkitfs tumor, and 16 (26.3%) were histiocytic type. Among the 5 remaining cases, 1 (1.7%) was diffuse lymphocytic poorly differ- entiated, and 4 (6.7%) were unclassifiable type. 4) The ratio of nodal to extranodal type was 1:3. The primary sites of tumors were the head and neck region (37.8%), including cervical lymph node, the abdomen (24.4%), and the mediastinum (19.5%). Only 3.7% of cases presented with tumors in peripheral lymph nodes outside the neck, while 12.2% of cases presented with tumors in a variety of other less common locations including skin, bone, epidural space and testis. 5) Thirty-seven of 82 cases (45.1%) presented with stage I or II localized disease in favorable sites. The remaining 45 cases (54.9%) had advanced stages, 16 (19.5%) had stage III, and 29 (35.4%) had stage IV. 6) The certain histologies correlated with certain sites. The lymphoblastic type typically presented within the head and neck (40.9%) or mediastinum (31.8%). In contrast, Burkitfs tumor virtually never involved the mediastinum or peripheral nodes, but typically arised in the abdomen (76.5%) or head and neck (23.5%). 7) Before 1985, all stages and histologies were entered on a single combined modality protocol (COMP, CCG 551, cyclophosphamide, vincristine, methotrexate, prednisolone). Since 1985, treatment was assigned based on both histology and bone marrow or CNS involvement. Patients with lymphob- lastic type were entered on an AD-COMP protocol (CCG 502, L-asparaginase, daunomycin+COMP). Non-lymphoblastic patients with bone marrow or CNS involvement were entered on a D-COMP protocol (CCG 503-11, daunomycin 4-COMP). Non-lymphoblastic patients without bone marrow or CNS involvement were entered on a COMP protocol (CCG 503- I). The 2 year event free survival (EFS) of all cases was 48.0+6.9%. With time there was successive improvement in the proportion of patients who were event free at 2 years from diagnosis, from 34.6±9.3% in the pre-1985 to 59.1± 9.8% since 1985. 8) The variables of potentially significant prognostic factors on EFS were examined with chi- square test. The era of treatment and serum LDH level were significantly related to EFS (p<0.05), but histology and the stage of disease were not. In summary, though the 2 year EFS was lower than previous other reports, there was a significant improvement (in 2 year EFS) since 1985. Improved supportive care and accumulated chemotherapy experience might contribute to this improvement.
Key Words: Non-Hodgkin's lymphoma. Histopathology, 2-year Event Free Survival


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