Weinstein / Hudson / Link Pediatric Lymphomas

1. Auflage 2007
ISBN: 978-3-540-68753-5
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 292 Seiten, Web PDF

Reihe: Medicine (R0)

The book covers the epidemiology, pathology, molecular biology, clinical features, diagnosis, and treatment of Hodgkin and non-Hodgkin lymphomas in children and adolescents. It is a combined effort of investigators who are leaders in the field of childhood lymphomas. Introductory chapters on Hodgkin and non-Hodgkin lymphomas in children provide a concise historical overview. All chapters have a standalone structure and those regarding the individual subtypes of lymphomas provide up-to-date results of recent clinical trials and practical guidelines for work-up and treatment. The pathology chapters are comprehensive and include excellent photographs as well as detailed review of the scientific advances pertaining to the molecular pathogenesis of each type of malignant lymphoma seen in childhood. There is also a concise chapter on post-transplant lympho-proliferative disease and lymphomas associated with congenital and acquired immunodeficiency states. The book is at the level of sub-specialists in pediatric hematology and oncology, radiation oncology, pediatric surgery and hematopathology.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Weinstein, Howard J.

Hudson, Melissa M.

Link, Michael P.

Inhaltsverzeichnis

and Historical Background: Pediatric Hodgkin Lymphoma.- Biology and Pathology of Hodgkin’s Disease.- Treatment of Pediatric Hodgkin Lymphoma.- Treatment of Relapsed/Refractory Hodgkin Lymphoma.- Non-Hodgkin’s Lymphoma.- Biology and Pathology of Pediatric Non-Hodgkin Lymphoma.- B-Cell Lymphoma/Burkitt Lymphoma.- Anaplastic Large-Cell Lymphoma.- Precursor B and Precursor T-Cell Lymphoblastic Lymphoma.- Cutaneous T-Cell Lymphomas and Rare T-Cell Non-Hodgkin Lymphomas.- Lymphoproliferative Disorders Related to Immunodeficiencies.- Late Effects Following Lymphoma Treatment.

Leseproben

(p.67-68)



4.1 Introduction

In the past 10.20 years, the treatment outcome for patients with pediatric Hodgkin disease (HL) has improved remarkably, however, 10.20% of the patients still relapse. Historically, retrieval approaches for patients with recurrent HL have utilized regimens that were previously used in frontline therapy. Generally, the degree of response to these regimens predicted the ability to rescue patients. In children and adolescents, the tolerance of salvage therapy has been exceptional, permitting the evaluation of novel therapeutic strategies. Given this fact, the introduction of new chemotherapeutic, immunologic and biologic agents is necessary to improve the response rate of pediatric patients with recurrent/refractory HL. Because of the signifi - cant risk of treatment-related secondary malignancies in pediatric patients associated with the use of alkylating agents and epipodophyllotoxin chemotherapy, agents frequently used in the treatment of HL (Krishnan et al. 2000, Pedersen-Bjergaard et al. 1997, Wheeler et al. 2001), alternative therapeutic approaches for retrieval that are both effi cacious and safe must be considered for pediatric patients with relapsed/refractory HL.

4.2 Strategies for Re-induction

Combined modality chemotherapy and radiotherapy have resulted in the cure of 80.90% of pediatric patients with HL. Approximately 10.20% of patients with advanced stage HL relapse aft er front-line treatment. Historically, a failure to respond to treatment with standard-dose conventional chemotherapy has resulted in low complete remission rates and minimal survival benefi t. Longo et al. reported a median survival of 16 months in patients who never attained a CR in a series of 51 patients treated with Methotrexate, Oncovin, Procarbazine and Prednisone (MOPP) (Longo et al. 1992). Likewise, Bonfante et al. reported similar results in patients who failed MOPP or MOPP/ABV hybrid or alternating regimens with a long-term eventfree survival (EFS) of 8% (Bonfante et al. 1997). Failure to respond or relapse is directly related to the duration of the initial response (Longo et al. 1992). Progression during induction therapy or within 12 months of completion of treatment resulted in a dismal prognosis with 5-year disease-free survival rates of 0% and 20%, respectively (Longo et al. 1992). Relapses occurring 12 months or later were amenable to salvage chemotherapy, but overall survival rates were 20.50% with conventional chemotherapy (Fisher et al. 1979, Longo et al. 1992, Viviani et al. 1990).

4.2.1 Role of Re-induction Chemotherapy

Response to cytoreductive ( re-induction) chemotherapy prior to high-dose therapy in patients with relapsed/ refractory HL predicts overall survival ( OS) regardless of the type of salvage therapy. Yuen et al. reported that sensitivity of disease refl ected by response to cytoreductive therapy prior to high-dose therapy in patients with relapsed/refractory HL was a signifi cant predictor of OS regardless of the type of salvage therapy (Yuen et al. 1997).