Hodgkin's disease in children in Southern Africa: Epidemiological characteristics, morbidity and long-term outcome
We reviewed 39 children < 15 years of age treated for Hodgkin's disease (HD) from 1973 to 1996. There were seven black, 12 white and 20 coloured children (of mixed ethnic origin). The M:F ratio was 2.9:1 and the median ages 147, 124 and 119 months in white, coloured and black children, respectively. Coloured and black children came mainly from a poor socio-economic background. Cervical lymphadenopathy was present in 74% and systemic symptoms in 51% of cases. Five per cent had clinical stage I, 41% stage II, 28% stage III and 26% stage IV disease. Two children underwent a staging splenectomy. The majority of white children presented with stages I and II and the majority of black and coloured children with stages III and IV HD. Nodular sclerosing (59%), mixed cellularity (40%) and lymphocyte-depleted (43%) were the most common histological subtypes in white, coloured and black children, respectively. Epidemiologically, white children fitted the criteria for HD type I and coloured and black children the criteria for HD type III. Nineteen children were treated with ChlVPP (chlorambucil, vinblastine, prednisone, procarbazine) and 20 with MOPP (mustine, Oncovin, procarbazine, prednisone) and/or ABVD (Adriamycin, bleomycin, vinblastine, DTIC) with involved field radiotherapy to bulky mediastinal disease. The projected 10-year survival after ChlVPP or MOPP/ABVD therapy was similar at 52%. In stages I and II, HD projected survival at 5 and 10 years was 85%, and in stages III and IV it was 82% at 5 and 48% at 10 years. The relapse rate was 47% in stage II, 45% in stage III and 44% in stage IV. Tuberculosis was suspected and treated in five children at the time of, and in seven children (three confirmed) subsequent to, the diagnosis of HD. Varicella developed in six and herpes zoster in five children. Five treatment-related deaths were due to septicaemia following splenectomy (two), marrow failure, cor pulmonale and secondary leukaemia.