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Klin Padiatr 2016; 228(06/07): 286-293
DOI: 10.1055/s-0042-110406
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© Georg Thieme Verlag KG Stuttgart · New York

Late Effects Following Treatment of Hodgkin Lymphoma During Childhood and Adolescence. Results of the Hodgkin Lymphoma Late Effects Research Project

Spätfolgen nach Behandlung eines Hodgkin Lymphoms im Kindes- und Jugendalter. Ergebnisse des Forschungsprojekts HD-Spätfolgen
W. Dörffel
1   Clinic for Pediatric and Youth Medicine, Helios Hospital Berlin-Buch, Berlin, Germany
,
M. Riepenhausen
2   Hodgkin Lymphoma Late Effect Research Project, University Children's Hospital Gießen, Gießen, Germany
,
H. Lüders
3   Protestant Lung Hospital, Berlin, Germany
,
J. Brämswig
4   University of Münster, Münster, Germany
› Author Affiliations
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Publication History

Publication Date:
15 November 2016 (online)

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Abstract

Survival rates have been excellent in patients treated for Hodgkin lymphoma (HL) during childhood and adolescence. Unfortunately, severe treatment related late effects have been observed. It was therefore an important aim of the cooperative pediatric HL therapy studies in Germany to reduce the number of late effects without jeopardizing the excellent treatment results. Progress and relapses of HL were analyzed to obtain important information for the future salvage therapy. All late effects were documented and their etiologies analyzed. Information obtained from bacterial infections and late deaths following splenectomy were used to inform patients at risk and their local physicians about necessary preventive measurements. Procarbazine was recognized as major gonadotoxic agent in boys and eliminated successively from the treatment regimens. Parenthood was normal in female patients when compared to the German female population documenting normal ovarian function except in patients with pelvic radiation. Radiation was the most important risk factor for thyroid diseases, cardiac late effects and subsequent malignant neoplasms, especially thyroid and breast cancer. A special screening program was initiated for women with chest radiotherapy, since they had a high risk of breast cancer already at a young age. The results of the HL Late Effects Research Project are important for the aftercare of patients and for the design of future HL treatment regimens.

Zusammenfassung

Die Heilungsraten von Hodgkin-Lymphom (HL)-Erkrankungen nehmen in der pädiatrischen Onkologie seit Jahrzehnten eine Spitzenposition ein. Aber auch Spätfolgen der Behandlung sind bei HL-Überlebenden besonders häufig und schwerwiegend. Die kooperativen pädiatrischen Hodgkin-Therapiestudien in Deutschland waren deshalb seit ihrem Beginn darauf ausgerichtet, das Spätfolgenpotenzial zu minimieren, ohne die guten Heilungsraten zu gefährden. Das Forschungsprojekt HD-Spätfolgen begleitete die Therapieoptimierungsstudien, um Spätfolgen zu dokumentieren und ihre Ursachen zu ermitteln. Es wurden auch HL-Rezidive und Progresse analysiert mit wichtigen Erkenntnissen für die künftige Salvagetherapie. Bakterielle Infektionen und Todesfälle nach Splenektomie gaben den Anlass zu einer Aufklärung aller Risikopatienten und ihrer behandelnden Ärzte über Möglichkeiten der Prävention. Die Analyse der kardialen Folgeerkrankungen identifizierte höhere lokale Radiotherapiedosen als wichtigsten Risikofaktor. Auch Schilddrüsenerkrankungen konnten als vorwiegend radiogen abgeklärt werden. Procarbazin wurde als relevante gonadotoxische Therapiekomponente beim männlichen Geschlecht erkannt und deshalb sukzessive aus den HL-Studien eliminiert. Eine gonadotoxische Chemotherapie konnte bei den Frauen nicht dokumentiert werden, da die Elternschaft der weiblichen Patientinnen der in der Allgemeinbevölkerung entsprach. In erster Linie die Strahlentherapie erhöht das Risiko für subsequente maligne Neoplasien. Am häufigsten wurden sekundäre Schilddrüsen- und Mammakarzinome diagnostiziert. Für Frauen wurde deshalb nach einer Bestrahlung von Anteilen der Brustdrüse ein Mammakarzinom-Früherkennungsprojekt in Deutschland gestartet. Die aus dem HD-Spätfolgen-Projekt gewonnenen Erkenntnisse führten zu einer Optimierung der HL-Therapie und auch der Nachsorge bei HL-Überlebenden.

Key words

pediatric Hodgkin lymphoma - aftercare - cardiac sequelae - late effects - radiogenic sequelae - secondary malignant neoplasms

Schlüsselwörter

Nachsorge - Kardiale Spätfolgen - Spätfolgen - radiogene Spätfolgen - sekundäre maligne Neoplasien - pädiatrisches Hodgkin Lymphom
 

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