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Late adverse effects in children, adolescents and young adults in relapsing and non-relapsing patients with Hodgkin lymphoma
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnonkologi)
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(English)Manuscript (preprint) (Other academic)
Keyword [en]
Late effects, children, adolescents, young adults, hospitalisation, Hodgkin
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-316794OAI: oai:DiVA.org:uu-316794DiVA: diva2:1079036
Available from: 2017-03-07 Created: 2017-03-07 Last updated: 2017-03-13
In thesis
1. Hodgkin Lymphoma in children, adolescents and young adults
Open this publication in new window or tab >>Hodgkin Lymphoma in children, adolescents and young adults
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Hodgkin lymphoma (HL) is a heterogeneous condition varying from engaging one single lymph node site to a widespread condition. The prognosis with contemporary treatment is excellent for the vast majority. However, the treatment might cause severe late adverse effects in a proportion of the affected individuals.

We evaluated all children and adolescents diagnosed in Sweden and registered in the Swedish Childhood Cancer Register over a period of 25 years. The incidence has been stable and the overall survival (OS) is very good, comparable to the best results in the world. Approximately ten percent encountered a relapse, but even after relapse the chances of survival were good. During the study period there were no detectable changes in survival estimates. The use of radiotherapy has decreased.

Epstein Barr virus (EBV) and numbers of eosinophils, mast cells and macrophages in the tumors were investigated in 98 cases. Young children were more likely to express EBV. In patients with advanced disease the mast cell and macrophage counts were higher and they also had more affected laboratory parameters. Patients with Nodular Lymphocyte Predominant Hodgkin Lymphoma did not express EBV in the tumor, had significantly lower numbers of eosinophils, mast cells and macrophages and less affected laboratory parameters compared to classical HL.

Outcome and clinical presentation were investigated in a cohort of children, adolescents and young adults in Sweden and Denmark and treatment in pediatric and adult departments was compared. OS and event-free survival (EFS) did not differ between the three age groups nor between pediatric and adult treatment. However, the Danish pediatric patients had lower EFS, which corresponded to less use of radiotherapy. Adolescents and young adults shared similar characteristics, while children presented differently with less advanced disease and male preponderance.

Hospitalization rates and outpatient visits after end of treatment were evaluated to see whether the excess need of resources described in the literature is evenly distributed among the survivors or whether it is limited to a smaller group. Most of the patients had a low burden of health care use and the relapsing patients were the main drivers of the excess need.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1314
Keyword
Hodgkin, pediatric, adolescent, young adults, microenvironment, eosinophils, mast cells, macrophages, Sweden, late adverse effects
National Category
Cancer and Oncology
Research subject
Pediatrics; Medical Science; Oncology
Identifiers
urn:nbn:se:uu:diva-316796 (URN)978-91-554-9851-1 (ISBN)
Public defence
2017-05-05, Rosénsalen, Ingång 95/96, Akademiska sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-04-12 Created: 2017-03-12 Last updated: 2017-04-21

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  • apa
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  • nn-NB
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