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Indian Journal of Medical and Paediatric Oncology
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Year : 2001  |  Volume : 22  |  Issue : 1  |  Page : 4-10

Childhood hodgkin's disease

Shrey Hospital, Navarangpura Amadavad-380009

Correspondence Address:
CJ Desai
Shrey Hospital, Navarangpura Amadavad-380009

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Source of Support: None, Conflict of Interest: None

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Childhood Hodgkin's disease (CHD) is a rare and a highly curable disease. In this article, the epidemiology, pathology, clinical features and management are briefly discussed. There is a bimodal age distribution of Hodgkin's disease. It is rare before 5 year of age is more common in boys. The majority of cases in developing countries are associated with the presence of Epstein-Barr virus in the Reed-Sternberg cells. Children with the disease need a special attention as the problems that arise in treatment and followup of childhood Hodgkin's disease can differ from those in adults and specialty care centres can best deal with these problems. Hodgkin's disease is a lymphoma characterised by a pleomorphic lymphocytic infiltrate with malignant multinucleated giant cells (Reed-Sternberg cells). The current histological classification for CHD used by pathologists is the Rye modification of the Lukes and Butler classification. Increased risk of second malignancy in this group suggests that one should minimise the use of agents associated with secondary malignancies in Hodgkin's disease. Nodular sclerosis is the most common histological subtype. With effective multiagent chemotherapy, histological subtype does not influence outcome. It is generally thought that Hodgkin's disease spreads contiguously via the lymphatics from one adjacent nodal area to another. The currently used staging system is the Ann Arbor stage classification. More than 90 percent of all children and adolescents with newly diagnosed Hodgkin's disease are curable with modern therapy. Selection of treatment is influenced by the stage of disease. Biopsy of lymph node or CT-guided core needle biopsy is required for diagnosis. CT scan of thorax is a sensitive method in staging the disease in the mediastinum, hila and lungs. Gallium 67 scan is a useful imaging modality for supradiaphragmatic disease. Due to increasing use of combined treatment modalities, staging laparotomy is no longer routinely used in most of the centres. It is very important that the children with Hodgkin's disease are treated at a specialised centre. Average 5-year survival of all patients (adults and children) with Hodgkin's disease in India is 37 percent. Almost all children with Hodgkin's disease receive combination chemotherapy with or without low dose (1,500-2,500 cGy) involved field radiation therapy as primary therapy. Combination chemotherapy regimens for children Hodgkin's disease include cyclophosphamide, vincristine, prednisone and procarbazine regimens such as COPP/ABV are often utilised. The risk of sterility, damage to the heart, lungs and thyroid, and second malignancies must be considered. For recurrent disease, alternate or noncross-resistant chemotherapy regimens are considered. Autologous bone marrow transplant may be more efficacious in those patients who have achieved a second remission with chemotherapy. Clinical trials exploring the efficacy of chemotherapy and bone marrow transplantation are currently ongoing for patients who have relapsed after initial chemotherapy.

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