In our study, 37 patients entered the study based on the criteria for entering the study. One of the patients was excluded from receiving the study due to unusual chemotherapy courses and the other one due to the incompleteness of the file. A total of 35 patients were examined. The duration of treatment, the duration of follow-up, and some paraclinical characteristics of patients were evaluated in Table 1.
Age and Sex
There were 19 (54.3%) male and 16 (45.7%) female with an age range between 3 and 16 years and a mean age of 10.58±3.08 years. Three cases (8.6%) of the children were under 5 years of age. The mean age of the boys in our study was 9.07±3.86 years and the mean age of the girls was 11.34±2.83 years, but no statistically significant difference was observed between the sexes in terms of age (P=0.07).
As our study results; 14 cases (40%) of Lymphocyte predominant HL, 10 cases (28.6%) of Nodular sclerosing HL, and 11 cases (31.4%) with Mixed cellularity HL reported.
In our study, the initial manifestation with which patients were referred to Motahari pediatric center was investigated. The most common complaints referred to the center were cervical lymphadenopathy in 22 cases (62.9%) 4 cases (11.5%) with abdominal lymph node involvement, 3 cases (8.7%) Abdominal and cervical involvement simultaneously, 2 cases (5.6%) mediastinal and neck involvement simultaneously, one case mediastinal involvement (2.8%), one case of inguinal lymphadenopathy (2.8%), one case of abdominal and axillary involvement (2.8%), and one case of simultaneous involvement of abdomen, mediastinum and neck (2.8%).
No metastasis was reported in 27 patients (75%). In 3 cases (8.3%) liver involvement, 2 cases (5.6%) splenic involvement, one case (2.8%), both liver and spleen involvement, two cases (5.6%), lung involvement, and in one case (2.8%), bone involvement was observed.
In our study, 30 patients (85.7%) received only chemotherapy and 5 (14.3%) patients treated with radiotherapy and chemotherapy simultaneously. The results of our study showed that 1 case (2.9%) of patients had only two chemotherapy courses, one patient had three chemotherapy courses (2.9%) and the rest had four chemotherapy courses. In our study, patients were evaluated based on the type of treatment (single chemotherapy, chemotherapy and radiotherapy) separately, which showed that there was no significant difference in the type of treatment and the stage of the disease (P=0.339).
Stage, Survival, and Response to Treatment
The results of the study indicated that the 5-year overall survival of patients was 97.1% in patients who treated with chemotherapy alone and one patient (2.9%) died for chemotherapy side effect. 34 patients (97.1%) were also alive. As … staging system 10 cases (28.6%) of patients in stage 1, 13 cases (37.1%) in stage 2, 9 cases (25.7%) in stage 3, and 3 cases (6.8%) of patients were in stage 4 of the lymphoma. The overall survival of patients in the low-risk stages (1 and 2) were 95.7% and in the high-risk stages (3 and 4) were 100%, which did not show a statistically significant difference (P=0.65). The overall response to treatment was 94.2%, and in one case the patient did not respond to initial chemotherapy and underwent radiotherapy and then chemotherapy. The overall response to treatment based on the stage of the disease did not differ significantly in the study (P=0.36). The rate of event-free survival was not significantly different in our study based on the stage of the disease (P=0.36). In low-risk stages (1 and 2) this rate was 85.7% and in high-risk stages it was 91.7%. the event-free survival based on the pathology subgroup was not significantly different in our study (P=0.957). Also, the event-free survival did not differ based on the presence or absence of metastasis (P=0.620). However, event-free survival was assessed based on the initial manifestation of the disease, and patients whose initial manifestation was cervical mass had significantly higher event-free survival rates (P = 0.011).
Among the patients studied, 4 cases (12.1%) had a relapsed after initial response to chemotherapy so radiotherapy was added to chemotherapy. The event-free survival rate during follow-up was 87.9%. Duration of the disease-free period in patients who had relapsed was 6.11±4.3 months.