HODGKINS-DISEASE IN CHILDREN IN SOUTHERN AFRICA - EPIDEMIOLOGIC CHARACTERISTICS, MORBIDITY AND LONG-TERM OUTCOME

We reviewed 39 children < 15 years of age treated for Hodgkin's diseas e (HD) from 1973 to 1996. There were seven black, 12 white and 20 colo ured children (of mixed ethnic origin). The M:F ratio was 2.9:1 and th e median ages 147, 124 and 119 months in white, coloured and black chi ldren, respectively. Coloured and black children came mainly from a po or 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 TV disease. Two chi ldren 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 ce llularity (40%) and lymphocyte-depleted (43%) were the most common his tological 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 m. Nineteen c hildren were treated with ChlVPP (chlorambucil, vinblastine, prednison e, procarbazine) and 20 with MOPP (mustine, Oncovin, procarbazine, pre dnisone) and/or ABVD (Adriamycin, bleomycin, vinblastine, DTIC) with i nvolved 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 rel apse rate was 47% in stage II, 45% in stage III and 44% in stage N. Tu berculosis was suspected and treated in five children at the time of, and in seven children (three confirmed) subsequent to, the diagnosis o f HD. Varicella developed in six and herpes tester in five children. F ive treatment-related deaths were due to septicaemia following splenec tomy (two), marrow failure, cor pulmonale and secondary leukaemia.