van den Berg H, Stuve W, Behrendt H
Department of Paediatric Oncology, University of Amsterdam, Emma Kinderziekenhuis, The Netherlands.
Med Pediatr Oncol. 1997 Jul;29(1):23-7. doi: 10.1002/(sici)1096-911x(199707)29:1<23::aid-mpo4>3.0.co;2-u.
Since the introduction of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy, children with Hodgkin's disease (HD) have been treated with chemotherapy alone. The occurrence of side effects related to irradiation (especially secondary solid tumors) is less likely to occur. Alkylating agents in the MOPP chemotherapy combinations are, however, known for their late effects, i.e., gonadal dysfunction and secondary malignancies. Combination with non-alkylating and non-cross-resistant drugs (as in the adriamycin, bleomycin, vinblastine, and dacarbazine [ABVD] combination: may give superior treatment results and possibly a decrease in the occurrence of side effects. From 1988 to 1993 all children presenting with HD were treated with alternating MOPP and ABVD courses (3 x MOPP, 3 x ABVD). Twenty-one children (7 females, 14 males), ages 5-18 years (median 14 years) were included; their clinical stages were 1, 7 patients; II, 8 patients; III, 5 patients; IV, 1 patient. Their pathology revealed 2 lymphocytic predominance, 17 nodular sclerosis, 1 mixed cellularity. In 1 patient only cytology was done and thus histopathologic subclassification was not possible. Two children have relapsed; disease-free survival is 90%. Analysis of toxicity revealed no decrease in cardiac function by ultrasound examination and no pulmonary effects noted by carbon monoxide diffusion. In 1 of the 10 children tested, mild hypogonadism was noted. No secondary tumors occurred. From this small population of children with HD we conclude that treatment with MOPP/ABVD for 6 cycles without radiotherapy may be adequate. The occurrence of gonadal dysfunction may be less frequent than with 6 cycles of MOPP. However, more patients and further follow-up are needed.
自从引入氮芥、长春新碱、丙卡巴肼和泼尼松（MOPP）化疗方案以来，霍奇金淋巴瘤（HD）患儿一直仅接受化疗。与放疗相关的副作用（尤其是继发性实体瘤）发生的可能性较小。然而，MOPP化疗方案中的烷化剂以其远期效应而闻名，即性腺功能障碍和继发性恶性肿瘤。与非烷化且无交叉耐药性的药物联合使用（如阿霉素、博来霉素、长春花碱和达卡巴嗪[ABVD]联合方案）可能会带来更好的治疗效果，并可能减少副作用的发生。1988年至1993年，所有HD患儿均接受MOPP和ABVD交替疗程（3个MOPP疗程，3个ABVD疗程）治疗。纳入了21名儿童（7名女性，14名男性），年龄5 - 18岁（中位数14岁）；其临床分期为：I期，7例；II期，8例；III期，5例；IV期，1例。其病理显示淋巴细胞为主型2例，结节硬化型17例，混合细胞型1例。有1例仅做了细胞学检查，因此无法进行组织病理学亚分类。2名儿童复发；无病生存率为90%。毒性分析显示，超声检查未发现心脏功能下降，一氧化碳弥散检查未发现肺部影响。在10名接受检测的儿童中，有1名出现轻度性腺功能减退。未发生继发性肿瘤。从这一小群HD患儿中我们得出结论，不进行放疗，采用MOPP/ABVD治疗6个周期可能就足够了。性腺功能障碍的发生率可能比6个周期的MOPP治疗更低。然而，需要更多患者和进一步的随访。
