Meriban KARADOĞAN, Uğur DEMİRSOY, Yonca Akgoz ANIK, Maksut Görkem AKSU, Funda ÇORAPÇIOĞLU

Pediatrik Non-Hodgkin Lenfoma: Türkiye'de Üçüncü Basamak Merkezi'nden Berlin-Frankfurt-Munster (BFM) Protokolleri ile On Yıllık Deneyim

Amaç: Çocukluk çağı Non-Hodgkin lenfoma (NHL) tedavisindeki ilerleme, son yirmi yılın çarpıcı başarı öykülerinden biridir. Gelişmiş ülkelerde, NHL'li çocukların %80'inden fazlası, yaygın hastalık durumunda bile modern terapi ile tedavi edilebilmektedir. Bu çalışmanın amacı, Türkiye'de tek bir üçüncü basamak merkezde tedavi edilen tüm NHL hastalarını analiz etmektir. Yöntem: Kocaeli Üniversitesi Pediatrik Onkoloji Anabilim Dalı'nda 2003-2012 yılları arasında orijinal Berlin-Frankfurt-Munster (BFM) protokolüne göre teşhis ve tedavi edilen NHL'li çocukların verilerinin analizi yapıldı. Bulgular: Kırk yedi çocuk analiz için uygun bulundu. Ortalama tanı yaşı 9.6, erkek:kadın oranı 1.9 idi. 31 hasta (%66) matür B hücreli NHL, 23 hasta (%48.9) Burkitt lenfoma, 7 hasta (%14.8) diffüz büyük B hücreli lenfoma, 1 hasta (%2) primer mediastinal büyük B hücreli lenfoma idi; 13 hasta (%27,6) lenfoblastik lenfoma, 11 hasta (%23,3) T-lenfoblastik lenfoma ve 2 hasta (%4,2) B-lenfoblastik lenfoma ve ayrıca 3 hasta (%6,3) matür T hücreli lenfoma-anaplastik büyük hücreliydi. lenfoma. Dört yıllık olaysız sağkalım %78.7 ve genel sağkalım %80.8 idi. Sonuç: BFM protokolü uygulamasıyla elde edilen bu sonuçlar, hastalarımızda iyi tedavi sonucunu yansıtmaktadır.

Anahtar Kelimeler:

çocuk, non-hodgkin lenfoma, Türkiye

Pediatric Non-Hodgkin Lymphoma: Ten-Year Experience with Berlin-Frankfurt-Munster (BFM) Protocols from a Tertiary Care Hospital in Turkey

Objective: Progress in therapy of childhood non-Hodgkin lymphoma (NHL) is one of the stunning success stories of the past two decades. In developed countries, more than 80% of children with NHL can now be cured with modern therapy, even patients with widely disseminated disease. The aim of this study is to analyze all NHL patients who were treated in a single tertiary center in Turkey. Methods: An analysis of data of children with NHL, diagnosed and treated between 2003 and 2012 according to the original Berlin-Frankfurt-Munster (BFM) protocol in Kocaeli University Pediatric Oncology Department was carried out. Results: Forty-seven children were eligible for analysis. Mean age at diagnosis was 9.6 years with a male: female ratio of 1.9. Thirty-one patients (66%) were mature B-cell NHL with 23 patients (48.9%) Burkitt lymphoma, 7 patients (14.8%) diffuse large B-cell lymphoma, 1 patient (%2) primary mediastinal large B-cell lymphoma; 13 patients (27.6%) were lymphoblastic lymphoma with 11 patients (23.3%) T-lymphoblastic lymphoma and 2 patients (4.2%) B-lymphoblastic lymphoma, and also 3 patients (6.3%) were mature-T cell lymphoma-anaplastic large cell lymphoma. Four-year event-free survival was 78.7% and overall survival was 80.8%. Conclusion: These results with BFM protocol administration reflect good treatment outcome in our patients.

Keywords:

children, non-hodgkin lymphoma, Turkey,

PDF

___

1. Lanzskowsky P. Non Hodgkin lymphoma. Manual of Pediatric Hematology and Oncology.5th edition Elsevier. 2011. P.624-646.
2. Thomas G. Gross, Sherrie L. Perkins. Malignant non-Hodgkin.s Lymphomas in Children. In: Pizzo PA and Poplack DG, editors. Principles and Practice of Pediatric Oncology. 6th edition. Lippincott Williams and Wilkins Company: Philadelphia; 2011. p.663-682.
3. Percy CL, Smith MA, Linet M, et al. Lymphomas and reticuloendothelial neoplasms. In: Ries LAG, Smith MA, Gurney JG, et al., eds. Cancer incidence and survival among children and adolescents. United States SEER Program 1975–1995. Bethesda, MD: National Cancer Institute, SEER Program, 1999:35–49. NIH Pub. No. 99–4649.
4. Sandlund JT, Downing JR, Crist WM, et al. Non-Hodgkin’s lymphoma in childhood. N Engl J Med 1996;334:1238–1248.
5. Perkins, SL. Work-up and diagnosis of pediatric non-Hodgkin’s lymphomas. PediatrDev Pathol 2000;3:374–90
6. Burkhardt B, Zimmermann M,Oschlies I, et al. The impact of age and gender on biology, clinical features and treatment outcome of non-Hodgkin Lymphoma in childhood and adolescence. Br J Haematol. 2005;131:39–49.
7. Dokmanovic L, Krstovski N, et al. Non-Hodgkin Lymphoma: A Retrospective 14-Year Experience with Berlin-Frankfurt-Munster(BFM) Protocols from a Tertiary Care Hospital in Serbia. Pediatric Hematology and Oncology, 2012; 29:109–118.
8. Baez F, Pillon M, Manfredini L, et al. Treatment of pediatric non-Hodgkin lymphomas in a country with limited resources: results of the first national protocol in Nicaragua. Pediatr Blood Cancer. 2008;50:148–152.
9. Murphy SB. Classification, staging and end results of treatment of childhood non-Hodgkin’s lymphomas: dissimilarities from lymphomas in adults. Semin Oncol. 1980;7:332–339
10. Moleti ML, Al-Hadad SA, Al-Jadiry MF, et al. Treatment of children with B-cell non-Hodgkin lymphoma in a low-income country. Pediatr Blood Cancer. 2011;56:560–567.
11. WHO classiﬁcation of tumors of hematopoietic and lymphoid tissues. Lyon, France: IARC, 2008.
12. King DR, Patrick LE, Ginn-Pease ME, et al. Pulmonary function is compromised in children with mediastinal lymphoma. J Pediatr Surg 1997;32:294–299; discussion 299–300.
13. Shamberger RC, Holzman RS, Griscom NT, et al. Prospective evaluation by computed tomography and pulmonary function tests of children with mediastinal masses. Surgery1995;118:468–471.
14. Jıa wang, Xv wu, Yuetıan shen et al. Paediatric lymphoma in China: a clinicopathological study of 213 cases Pathology (December 2012) 44(7), pp. 622–625.
15. Fadoo Z, Belgaumi A, Alam M, et al. Pediatric lymphoma: a 10-year experience at a tertiary care hospital in Pakistan. J Pediatr Hematol Oncol2010; 32: e14–
16. Baez F, Pillon M, Manfredini L, et al. Treatment of pediatric non-Hodgkin lymphomas in a country with limited resources: results of the first national protocol in Nicaragua. Pediatr Blood Cancer. 2008;50:148–152.
17. Chantada G, Casak S, Alderete D, et al. Treatment of B-cell malignancies in children with a modified BFM-NHL 90 protocol in Argentina. Med Pediatr Oncol. 2003;41:488–490.
18. Reiter A, Schrappe M, Parwaresch R, et al. Non-Hodgkin’s lymphomas of childhood and adolescence: Results of a treatment stratified for biologic subtypes and stage. A report of the Berlin Frankfurt-Munster Group. J Clin Oncol 1995;13:359–372.
19. Gerrard M, Cairo MS, Weston C, et al. Excellent survival following two courses of COPAD chemotherapy in children and adolescents with resected localized B-cell non-Hodgkin’s lymphoma: Results of the FAB/LMB 96 international study. Br J Haematol 2008;141:840–847.
20. Tsurusawa M, Mori T, et al. Improved Treatment Results of Children With B-Cell Non-Hodgkin Lymphoma: A Report From the Japanese Pediatric Leukemia/Lymphoma Study Group B-NHL03 Study. Pediatr Blood Cancer 2014;61:1215–1221
21. Neth O, Seidemann K, Jansen P, et al. Precursor B-cell lymphoblastic lymphoma in childhood and adolescence: clinical features, treatment, and results in trials NHL-BFM86 and 90. Med Pediatr Oncol 2000;35:20–27.
22. Reiter A, Schrappe M, Ludwig WD, et al. Intensive ALL-type therapy without local radiotherapy provides a 90% event-free survival for children with T-cell lymphoblastic lymphoma: a BFM group report. Blood 2000;95:416–421
23. Brugieres L, Deley MC, Pacquement H, et al. CD30(+) anaplastic large-cell lymphoma in children: analysis of 82 patients enrolled in two consecutive studies of the French Society of Pediatric Oncology. Blood. 1998;92(10):3591–3598.
24. Salzburg J, Burkhardt B, Zimmermann M, et al. Prevalence, clinical pattern, and outcome of CNS involvement in childhood and adolescent non-Hodgkin’s lymphoma differ by non-Hodgkin’s lymphoma subtype: a Berlin-Frankfurt-Munster Group Report. J Clin Oncol. 2007;25:3915–3922.