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Lymphocyte-Predominant Hodgkin’s Lymphoma in Children: Therapeutic Abstention After Initial Lymph Node Resection—A Study of the French Society of Pediatric Oncology

B. Pellegrino, M.J. Terrier-Lacombe, O. Oberlin, T. Leblanc, Y. Perel, Y. Bertrand, C. Beard, C. Edan, C. Schmitt, D. Plantaz, H. Pacquement, J.P. Vannier, C. Lambilliote, G. Couillault, A. Babin-Boilletot, I. Thuret, F. Demeocq, G. Leverger, G. Delsol, J. Landman-Parker

From the Departments of Pediatric Hematology/Oncology of Hôpital Armand Trousseau, Hôpital Saint Louis, AP-HP; and Institut Curie, Paris; Institut G. Roussy, Villejuif; Hôpital Debrousse, Centre Léon Berard, Lyon; Hôpital Pellegrin, Bordeaux; Hôpital Americain, Reims; Hôpital Sud, Rennes; Hôpital d’Enfants, Nancy; Hôpital A. Michalon, Limoges; Hôpital C. Nicolle, Rouen; Hôpital J. de Flandre, Lille; Hôpital d’Enfants, Dijon; Hôpital Hautepierre, Strasbourg; Hôpital La Timone, Marseille; Hôtel Dieu, Clermont Ferrand; and Pathology Departments of Hôpital Purpan, Toulouse; and Institut Gustave Roussy, Villejuif, France.

Address reprint requests to Judith Landman-Parker, MD, Service d’Hématologie et d’Oncologie Pédiatrique, Hôpital d’Enfants Armand Trousseau; 26 ave Arnold Netter, Paris 75012, France; email: judith.landman-parker{at}trs.ap-hop-paris.fr.

Purpose: To clarify treatment strategy for lymphocyte-predominant Hodgkin’s lymphoma (LPHL), the French Society of Pediatric Oncology initiated a prospective, nonrandomized study in 1988. Patients received either standard treatment for Hodgkin’s lymphoma or were not treated beyond initial adenectomy.

Patients and Methods: From 1988 to 1998, 27 patients were available for study. Twenty-four patients were male, and median age was 10 years (range, 4 to 16 years). Twenty-two, two, and three patients had stage I, II, and III disease, respectively. Thirteen patients (stage I, n = 11; stage III, n = 2) received no further treatment after initial surgical adenectomy (SA). Fourteen patients received combined treatment (CT; n = 10), involved-field radiotherapy alone (n = 1), or chemotherapy alone (n = 3). The two groups were comparable for clinical status, treatment, and follow-up.

Results: Twenty-three of 27 patients achieved complete remission (CR). With a median follow-up time of 70 months (range, 32 to 214 months), overall survival to date is 100%, and overall event-free survival (EFS) is 69% ± 10% (SA, 42% ± 16%; CT, 90% ± 8.6%; P < .04). If we considered only the patients in CR after initial surgery (n = 12), EFS was no longer significantly different between the two groups. Patients with residual mass after initial surgery (n = 15) had worse EFS if they did not receive complementary treatment (P < .05).

Conclusion: Although based on a small number of patients, our study showed that (1) no further therapy is a valid therapeutic approach in LPHL patient in CR after initial lymph node resection, and (2) complementary treatment diminishes relapse frequency but has no impact on survival.

Preliminary results of this study were reported at the Annual Meeting of the American Society of Hematology, December 3–7, 1999, New Orleans, LA (abstract 2366).

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