Disease patterns of pediatric non‑Hodgkin lymphoma: A study from a developing area in Egypt

Sherief,Laila  M.; Elsafy,Usama  R.; Abdelkhalek,Elhamy  R.; Kamal,Naglaa  M.; Youssef,Doaa  M.; Elbehedy,Rabab

doi:10.3892/mco.2014.425

Disease patterns of pediatric non‑Hodgkin lymphoma: A study from a developing area in Egypt

Authors:
- Laila M. Sherief
- Usama R. Elsafy
- Elhamy R. Abdelkhalek
- Naglaa M. Kamal
- Doaa M. Youssef
- Rabab Elbehedy
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Affiliations: Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Al Sharqiyah, Egypt, Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
Published online on: September 24, 2014 https://doi.org/10.3892/mco.2014.425
Pages: 139-144

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Abstract

Non‑Hodgkin lymphoma (NHL) accounts for 8‑10% of all childhood cancers. NHL collectively represents various lymphoid malignancies with diverse clinicopathological and biological characteristics. In this study, we aimed to describe the epidemiological and clinicopathological characteristics and treatment outcomes of pediatric NHL patients treated at the Pediatric Oncology Unit of Zagazig University Hospital and the Benha Specialized Pediatric Hospital. We conducted a cross‑sectional retrospective study by reviewing the medical records of 142 patients admitted with a diagnosis of NHL over a period of 8 years (February, 2004 to February, 2012) in these two Oncology Units. The age at presentation ranged between 2 and 15 years, with a mean ± standard deviation (SD) of 6.1±2.8 years and a male:female ratio of 1.7:1. Abdominal involvement was the most common presentation (73.2%). Burkitt's lymphoma (BL) was the most common NHL subtype (69%), followed by lymphoblastic lymphoma, diffuse large B‑cell lymphoma and anaplastic large‑cell lymphoma, accounting for 18.3, 10.6 and 2.1% of the cases, respectively. The majority of the patients (88.7%) had been diagnosed with advanced disease (Murphy stage III/IV). Complete remission was achieved in 120 cases (84.5%). A total of 16 patients (11.3%) succumbed to the disease during the first few months and 6 patients (4.2%) remained alive following relapse. The mean follow‑up duration ± SD was 34.6±25.1 months (range, 3‑84 months). the 5‑year overall survival (OS) and event‑free survival (EFS) rates were 88.7 and 85.1%, respectively. None of the clinical, epidemiological or pathological variables exhibited a statistically significant association with the OS or EFS. In conclusion, NHL occurs at a younger age, with a higher incidence of BL and advanced‑stage disease. The outcome of NHL in our two centers was satisfactory, approaching the international rates.

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1	Sandlund JT, Downing JR and Crist WM: Non-Hodgkin's lymphoma in childhood. N Engl J Med. 334:1238–1248. 1996.
2	Cairo MS, Raetz E, Lim MS, et al: Childhood and adolescent non-Hodgkin lymphoma: new insights in biology and critical challenges for the future. Pediatr Blood Cancer. 45:753–769. 2005. View Article : Google Scholar : PubMed/NCBI
3	Gross TG and Termuhlen AM: Pediatric non-Hodgkin's lymphoma. Curr Oncol Rep. 9:459–465. 2007.
4	Hochberg J, Waxman IM, Kelly KM, et al: Adolescent non-Hodgkin lymphoma and Hodgkin lymphoma: state of the science. Br J Haematol. 144:24–40. 2009. View Article : Google Scholar : PubMed/NCBI
5	Brousse N, Vasiliu V, Michon J, et al: Pediatric non-Hodgkin lymphomas. Ann Pathol. 24:574–586. 2004.(In French).
6	Setty BA and Termuhlen AM: Rare pediatric non-Hodgkin lymphoma. Curr Hematol Malig Rep. 5:163–168. 2010. View Article : Google Scholar : PubMed/NCBI
7	Sharon V, Mecca PS, Steinherz PG, et al: Two pediatric cases of primary cutaneous B-cell lymphoma and review of the literature. Pediatr Dermatol. 26:34–39. 2009. View Article : Google Scholar : PubMed/NCBI
8	Swerdlow SH: Pediatri. follicular lymphomas, marginal zone lymphomas, and marginal zone hyperplasia. Am J Clin Pathol. 122 Suppl:S98–S109. 2004.PubMed/NCBI
9	Lones MA, Perkins SL, Sposto R, et al: Non-Hodgkin lymphoma arising in bone in children and adolescents is associated with an excellent outcome: a Children's Cancer Group Report. J Clin Oncol. 20:2293–2301. 2002.PubMed/NCBI
10	Gatta G, Corazziari I, Magnani C, Peris-Bonet R, Roazzi P and Stiller CEUROCARE Working Group: Childhood cancer survival in Europe. Ann Oncol. 14 (Suppl 5):v119–v127. 2003. View Article : Google Scholar : PubMed/NCBI
11	Gross TG and Perkins SL: Malignant non-Hodgkin's lymphoma in children. Principles and Practice of Pediatric Oncology. Pizzo PA and Poplack DG: 6th. Lippincott Williams: Philadelphia: pp. 663–682. 2011
12	Gutierrez MI, Bhatia K, Barriga F, et al: Molecular epidemiology of Burkitt's lymphoma from South America: differences in breakpoint location and Epstein-Barr virus association from tumors in other world regions. Blood. 79:3261–3266. 1992.
13	Jaffe ES, Harris NL, Stein H, et al: Introduction and overview of the classification of the lymphoid neoplasms. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J and Vardiman JW: 4th. IARC Press; Lyon: pp. 157–166. 2008
14	Murphy SB: Classification, staging and end results of treatment of childhood non-Hodgkin's lymphomas: dissimilarities from lymphomas in adults. Semin Oncol. 7:332–339. 1980.PubMed/NCBI
15	Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL and Bruin GR: Cance. Incidence and Survival Among Children and Adolescents: United States SEER Program 1975–1995. National Cancer Institute, SEER Program; : Bethesda, MD: 1999
16	Pedrosa MF, Pedrosa F, Lins MM, et al: Non-Hodgkin's lymphoma in childhood: clinical and epidemiological characteristics and survival analysis at a single center in Northeast Brazil. J Pediatr (Rio J). 83:547–554. 2007.
17	Sandlund JT, Fonseca T, Leimig T, et al: Predominance and characteristics of Burkitt lymphoma among children with non-Hodgkin lymphoma in northeastern Brazil. Leukemia. 11:743–756. 1997. View Article : Google Scholar : PubMed/NCBI
18	Klumb CE, Schramm MT, De Resende LM, et al: Treatment of children with B-cell non-Hodgkin's lymphoma in developing countries: the experience of a single center in Brazil. J Pediatr Hematol Oncol. 26:462–468. 2004.
19	Manipadam MT, Nair S, Viswabandya A, et al: Non-Hodgkin lymphoma in childhood and adolescence: frequency and distribution of immunomorphological types from a tertiary care center in South India. World J Pediatr. 7:318–325. 2011. View Article : Google Scholar : PubMed/NCBI
20	Harris NL, Jaffe ES, Diebold J, et al: Word Health Organization classification of neoplastic disease of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol. 17:3835–3849. 1999.
21	Naresh KN, Agarwal B, Nathwani BN, et al: Use of the World Health Organization (WHO) classification of non-Hodgkin's lymphoma in Mumbai, India: a review of 200 consecutive cases by a panel of five expert hematopathologists. Leuk Lymphoma. 45:1569–1577. 2004.
22	Temmim L, Baker H, Amanguno H, et al: Clinicopathological features of extranodal lymphomas: Kuwait experience. Oncology. 67:382–389. 2004. View Article : Google Scholar : PubMed/NCBI
23	Wright D, McKeever P and Carter R: Childhood non-Hodgkin lymphomas in the United Kingdom: findings from the UK Children's Cancer Study Group. J Clin Pathol. 50:128–134. 1997.
24	Burkhardt B, Zimmermann M, Oschlies I, et al BFM Group: The impact of age and gender on biology, clinical features and treatment outcome of non-Hodgkin lymphoma in childhood and adolescence. Br J Haematol. 131:39–49. 2005. View Article : Google Scholar : PubMed/NCBI
25	Mokhtar N and Khaled H: Lymphoma. 1st. Aventis Oncol; Cairo: pp. 47–63. pp. 123–134. 2002
26	Srinivas V, Soman CS and Naresh KN: Study of the distribution of 289 non-Hodgkin lymphomas using the WHO classification among children and adolescents in India. Med Pediatr Oncol. 39:40–43. 2002. View Article : Google Scholar : PubMed/NCBI
27	Magrath IT: African Burkitt's lymphoma. History, biology, clinical features, and treatment. Am J Pediatr Hematol Oncol. 13:222–246. 1991.
28	Hwang IG, Yoo KH, Lee SH, et al: Clinicopathologic features and treatment outcomes in malignant lymphoma of pediatric and young adult patients in Korea: comparison of Korean all-ages group and Western younger age group. Clin Lymphoma Myeloma. 7:580–586. 2007. View Article : Google Scholar
29	Nakagawa A, Nakamura S, Nakamine H, et al: Pathology review for paediatric non-Hodgkin's lymphoma patients in Japan; a report from the Japan association of childhood leukemia study (JACLS). Eur J Cancer. 40:725–733. 2004.
30	Jaffe ES, Harris NL, Stein H and Vardiman JW: Patholog. and genetics of tumours of haematopoietic and lymphoid tissues. World Health Organization Classification of Tumours. 3rd. IARC Press; Lyon: pp. 227–230. 2001;
31	Anderson JR, Armitage JO and Weisenburger DD: Epidemiology of the non-Hodgkin's lymphomas: distributions of the major subtypes differ by geographic locations. Non-Hodgkin's Lymphoma Classification Project. Ann Oncol. 9:717–720. 1998.
32	Patte C: Non-Hodgkin's lymphoma. Eur J Cancer. 34:359–363. 1998.
33	Boerma EG, van Imhoff GW, Appel IM, et al: Gender and age-related difference in Burkitt lymphoma - epidemiological and clinical data from The Netherlands. Eur J Cancer. 40:2781–2787. 2004. View Article : Google Scholar : PubMed/NCBI
34	Pinkerton CR: The continuing challenge of treatment for non-Hodgkin's lymphoma in children. Br J Haematol. 107:220–234. 1999.
35	Perkins SL: Work-up and diagnosis of pediatric non-Hodkin's lymphomas. Pediatr Dev Pathol. 3:374–390. 2000.
36	Temmim L, Baker H, Al-Jarallah M, et al: Clinical characteristics and pathological classification of non-Hodgkin's lymphoma in Kuwait. Results of a collaborative study with the International Lymphoma Study Group (ILSG). Leuk Lymphoma. 45:1865–1871. 2004.
37	Reiter A, Schrappe M, Parwaresch R, et al: Non-Hodgkin's lymphomas of childhood and adolescence: results of a treatment stratified for biologic subtypes and stage - a report of Berlin-Frankfurt-Münster Group. J Clin Oncol. 13:359–372. 1995.
38	Reiter A, Schrappe M, Ludwig WD, et al: Intensive ALL-type therapy without local radiotherapy provides a 90% event-free survival for children with T-cell lymphoblastic lymphoma: a BFM group report. Blood. 95:416–421. 2000.PubMed/NCBI
39	Link MP, Shuster JJ, Donaldson SS, et al: Treatment of children and young adults with early-stage non-Hodgkin's lymphoma. N Engl J Med. 337:1259–1266. 1997.PubMed/NCBI
40	Seidemann K, Tiemann M, Schrappe M, et al: Short-pulse B-non-Hodgkin lymphoma-type chemotherapy is efficacious treatment for pediatric anaplastic large cell lymphoma: a report of the Berlin-Frankfurt-Munster Group Trial NHL-BFM 90. Blood. 97:3699–3706. 2001. View Article : Google Scholar
41	Laver JH, Kraveka JM, Hutchison RE, et al: Advanced-stage large-cell lymphoma in children and adolescents: results of a randomized trial incorporating intermediate-dose methotrexate and high-dose cytarabine in the maintenance phase of the APO regimen: a Pediatric Oncology Group phase III trial. J Clin Oncol. 23:541–547. 2005. View Article : Google Scholar