Hodgkin Lymphoma: 30-Year Experience. What is Changed?

Background: Since 1983, 4 treatment protocols for pediatric Hodgkin Lymphoma were utilized and1,733 pts were registered. What clinical characteristics have been changed in the last 30 years?

Methods: This is an observational retrospective study of pts registered from 1983 till now in 4 subsequent protocols MH83, MH89, MH96 and LH2004. The analysis included eligible and evaluable pts:211 in MH83 protocol, 259 in MH89, 560 in MH96 and703 in LH2004. We compared two groups:> 5 – 10 and> 10 – 15yrs old pts because subjects younger that 5yrs were too few and pts > 15yrs were enrolled only in the last two protocols.

Results: Patient distribution according to stage (Ann-Arbor classification) and sex is essentially unchanged in the four protocols.

As far as age in concerned, it was noticed a progressive decrease of the < 10 yr-old pts: 38.3% (MH83), 30% (MH89), 21.4% (MH96) and 14% (LH2004) (p = 0.05).

About histology, it was found a progressive decline in the mixed cellularity variant from protocol MH'83 to LH2004 both in the> 5 – 10 yr-group (from MH83: 40.5% to LH2004: 16.4%) and in the> 10 – 15 yr-group (from MH83: 22.7% to LH2004: 6.8%) (p = 0.000003). On the other hand, a progressive increase of the nodular sclerosis variant was observed in both groups: from MH83: 37.9% to LH2004 63.5% in> 5 – 10 yr old pts; from MH83: 64.5% to LH2004: 81.8% in> 10 – 15 yr old pts (p = 0.000061). This trend replicates the relation between age and histological variant. No relevant changes regarding the lymphocyte-predominance, but the confirmation of decrease with the older age of the patient.

Conclusion: During the last 30 years a significant change in the incidence of> 5 – 10 and> 10 – 15yrs old pts and of histological variants has been observed; if it is related with clinical outcome will be the objective of a further study.