Non Hodgkin's Lymphoma in Paediatrics and Adolescents

in Term of Survival and Disease Free Survival

By

ABSTRACT

There are a number of options for salvage treatment in children and adolescents with relapsed and refractory classical Hodgkin Lymphoma. These include salvage with standard dose chemotherapy, high dose chemotherapy with autologous stem cell transplant, allogeneic stem cell transplant or other novel approach. Radiotherapy has an important role in the salvage of some patients as part of a combined modality approach. This review outlines these salvage approaches and discusses whether the evidence from paediatric studies justifies a risk-adapted approach to salvage for individual patients or whether all patients should receive consolidation with high dose chemotherapy and autologous stem cell transplantation, which is often described as standard salvage management in adults. The important prognostic factors and how these may be used to allocate patients to standard versus high dose chemotherapy regimens are discussed. The role of allogeneic transplantation, novel agents and late effects will also be discussed.

The cure rates of first-line treatment for classical Hodgkin lymphoma (HL) in children are very high with the use of modern effective chemotherapy, often used in combination with involved field radiotherapy (IFRT). The most effective regimens achieve cure rates in excess of 90% for early Stage and 80% for advanced Stage disease, with equivalent outcomes for adolescents and children. Single modality radiotherapy (RT) is rarely used now as primary treatment due to unacceptable failure rates even in low stage patients. Paediatric paradigms for primary treatment have evolved to reduce late effects whilst maintaining excellent cure rates), achieved by developing chemotherapeutic regimens that minimize late toxicity and, when given, RT is low dose (20-25 Gy) and involved field. Primary chemotherapy is allocated using a risk-adapted approach utilizing prognostic factors associated with primary treatment failure, and response to chemotherapy is under study to GUide either the final number of chemotherapy cycles, or to limit or remove RT in patients who achieve complete remission with chemotherapy alone.

For the purpose of this dissertation, quantitative research method was used. A quantitative research methodology was employed in the study. A quantitative methodology is the most appropriate means of estimating the survival rate of patients diagnosed or treated with Non-Hodgkin's Lymphoma at King Abdul-Aziz Medical City-Riyadh; the patients being children (0-12) and adolescents (13-18) during the interval 1994-2011. The quantitative design uses the basic steps described by Creswell (2008). A sample of fifty-four (n = 54) Non Hodgkin's lymphoma patients admitted to the NGHA oncology department from (1994-2003) were considered for this study. The Primary site for the Non Hodgkin's lymphoma patients were found to be from Lymph nodes in 23 (42.59%), Medistinum in 9 (16.67%), GI in 7 (12.96%), Extra lymphatic tissues in 3 (5.56%), Nasopharynx in 3 (5.56%), Bone in 2 (3.70%), Breast in 1 (1.85%) and Others in 3 (5.56%) of the total patents.

Glossary of Terms

DLBCL: Diffuse large B-cell lymphoma

DNA: Deoxyribo Nucleic Acid

NHL: Non-Hodgkin lymphoma

SEER: Surveillance, Epidemiology, and End Results

PKC: Protein kinase C

Acknowledgement

First of all, I would like to thank God for giving me the strength ...