Malignant Lymphoma In Childhood Research Articles

Clinical implication of distinction from clinical features and treatment outcome of malignant lymphoma in Korean childhood and young adult

18534 Background: The Clinicopathologic features of malignant lymphomas vary to geography and differ to age. The goal of this study was to find the implication of distinction from biology, clinical features and treatment outcome of malignant lymphoma in childhood and young adult. Methods: We analysed the clinical features including age, gender, histologic type, and treatment outcome of 294 children and young adults during 13-year period (from May 1993 to November 2005) in Samsung medical center and compared our study to all age group and western childhood and adolescence group on clinical features or treatment outcome in malignant lymphoma. Results: Median age at diagnosis was 20.7 years (range: 0.1–30.1 years). Male to female ratio was 1.37:1, Of 294 cases, there were 248 cases of non-hodgkin’s lymphoma (NHL) (84.3%) and 44 cases of hodgkin’s disease (HD) (15%). This rate was significantly different to rate of all age group (HD= 5.3%) (p=0.001). Of 248 cases of non-hodgkin’s lymphoma, 134 cases (54.0%) were B-lineage and 113 cases (45.6%) were T- or NK-cell lineage. Our study group had higher rates of T- or NK-cell NHL compared to all age group (p=0.001) and western group (p=0.001). Among 248 cases of NHL, the most common histologic type was diffuse large cell lymphoma (DLBL) in our study group. Burkitt’s lymphoma (BL) was the most common histologic types in Western study group. 5-year survival rate (5YSR) was 80.4% and was superior for BL and was inferior for NK/T cell lymphoma. However male T-LBL patients had better outcome in western study group. NHL and T-cell NHL had significantly worse outcomes than HD and B-cell NHL (p=0.049, 0.001, respectively). Comparing age-groups 0–10, 10–20 and 20–30, 5YSR was inferior for the oldest patients only in NHL-, T-cell NHL- and T-cell LBL-groups. Conclusions: Our study suggested environmental and genetic factor was associated with the development of malignant lymphoma. No significant financial relationships to disclose.

Bone mineral status after treatment of malignant lymphoma in childhood and adolescence

The relationship between bone mineral mass and cumulative dose of corticosteroids (CDC) was investigated in 42 children and adolescents treated for Hodgkin disease (HD; n = 22) and non-Hodgkin lymphoma (NHL; n = 20). The median age at the time of the study was 24.1 years for HD survivors and 14.1 years for NHL survivors. Dual-energy X-ray absorptiometry [bone mineral density of the lumbar spine (LS-BMD) expressed as Z-scores] and peripheral quantitative computed tomography at the distal radius [trabecular volumetric BMD (vBMD-trab)] were undertaken. Osteopenia (Z-score < -1.00) was found in 9/22 patients with HD and 10/20 with NHL, while 34% (HD = 6, NHL = 8) had a vBMD-trab below the normal range. The CDC correlated inversely with LS-BMD Z-score (r =-0.41, P = 0.007). There was a statistically significantly higher vBMD-trab in patients who received low (1-4 g/m(2)) compared with high (>or=20 g/m(2)) CDC (P = 0.031). Treatment of malignant lymphoma with high CDC is a risk factor for development of osteopenia.

Degree of fatness after treatment of malignant lymphoma in childhood.

Sex hormone deficiency or growth hormone deficiency may cause excess fatness after treatment for childhood malignant lymphoma. Previous studies of the body composition after treatment for childhood cancer included few survivors of malignant lymphoma who were not analysed separately. We measured the whole-body percent fat by dual energy X-ray absorptiometry (DXA) and the body-mass index (weight/height(2) (kg/m(2)), BMI) in survivors of childhood Hodgkin disease (n = 23) or non-Hodgkin lymphoma (n = 21) a median of 11 years after diagnosis (range 2-25). Results were compared with local data on 463 healthy controls. Adjusted for sex and age, the mean BMI did not differ from that of local controls, but the mean whole-body percent fat was significantly increased (0.8 SD above predicted, P = 0.0001). Sixteen of 44 participants had a percent fat above the 90 percentile of the reference values, which indicates excess fatness. Adjusted for sex and age, percent fat was significantly higher in persons treated for non-Hodgkin lymphoma. Controlled for this, the whole-body percent fat was not significantly related to sex, age at diagnosis, length of follow-up, sex hormone therapy at follow-up or the cumulative dose of corticosteroids or doxorubicin. Eleven years after diagnosis of childhood Hodgkin disease or non-Hodgkin lymphoma, the whole-body percent fat was increased whereas the BMI was like that of the controls. This indicates a reduced lean body mass.

Bone mass after treatment of malignant lymphoma in childhood.

Sex hormone deficiency, growth hormone deficiency, skeletal irradiation, and treatment with corticosteroids or methotrexate may all cause reduction in bone mass after treatment for childhood malignant lymphoma. Previous studies of the bone mass of childhood cancer survivors often lacked adequate local reference data, and survivors of malignant lymphoma were never analyzed separately. The bone mass of survivors of childhood Hodgkin disease (n = 23) or non-Hodgkin lymphoma (n = 21) was measured by dual-energy X-ray absorptiometry a median of 11 years after diagnosis (range 2-25). Results were compared with local data on 463 healthy controls. Adjusted for gender and age, the mean whole-body bone mineral content and bone mineral areal density were slightly, but significantly, reduced (0.5 and 0.4 SD lower than predicted). The reduced bone mineral content was associated with a significantly reduced height, whereas the size-adjusted bone mass (bone mineral content for bone area) did not differ significantly from that of controls. Lower height was related to male gender and to cranial, thoracic, and lumbar spine irradiation. Whole-body bone mineral content and bone mineral density were lower in persons treated with lumbar spine irradiation and whole-body bone mineral content was higher in nine women receiving sex hormone replacement therapy or oral contraceptives. Whole-body bone mass was not related to the cumulated doses of corticosteroids or methotrexate. Eleven years after diagnosis of childhood Hodgkin disease or non-Hodgkin lymphoma, the whole-body bone mass of survivors was only slightly reduced and the size-adjusted bone mass was normal.

Risk factors for reduced pulmonary function after malignant lymphoma in childhood.

The aim was to study pulmonary function after Hodgkin disease or non-Hodgkin Lymphoma in childhood and to evaluate if younger age at diagnosis and therapy is a risk factor for reduced pulmonary function. We studied a population-based sample of survivors of Hodgkin disease (n = 22) or non-Hodgkin lymphoma (n = 19) in childhood. Pulmonary function test results were compared with reference values for our laboratory, generated by adjusting published reference values fit 348 healthy never-smokers from a local population study. Data were analyses as standardised residuals, which are [observed minus predicted value] divided by the residual standard deviation of the reference equations. At a median of 11 years after diagnosis (range 2 to 24), the participants had significantly reduced lung volumes and transfer factor, unrelated to the few pulmonary symptoms. On average, the total lung capacity was reduced to -0.9 standardised residual and the transfer factor was reduced to -1.3 standardised residual. Young age at therapy seemed to be a risk factor for reduced lung function, especially when treatment included thoracic irradiation. No significant toxic synergism was observed between smoking and previous cancer therapy. Therapy without thoracic irradiation but with doxorubicin and cyclophosphamide was almost as toxic to lung function as therapy with thoracic irradiation but without doxorubicin and cyclophosphamide. In conclusion, lung volumes and transfer factor were reduced several years after childhood Hodgkin disease of non-Hodgkin lymphoma, with young age at therapy as a risk factor, especially when combined with thoracic irradiation.

Malignant lymphoma in childhood. Ultrasound diagnosis

The sonographic diagnosis of malignant lymphoma in childhood is described. Malignant lymphomas are sonographically relatively uniform: initial enlargement of the lymph nodes and organs involved and disturbance of normal echo texture by mainly hypoechoic lesions can be found. Generally, four sonographic patterns of infiltration are described: diffuse, small nodular, large nodular and bulky type. Secondary, tumor-related or inflammatory complications (e.g. dislocation or compression of vessels, thoracic inlet syndrome, venous thrombosis, ileus, urinary retention, abscess and effusion) can be sonographically evaluated. Response to therapy correlates with normalization of size and echo texture and recovery from tumor-related complications. Differential diagnosis with ultrasound is based on the topographic distribution and echo pattern of infiltration and, with certain restrictions, on the echogenicity of lesions and perfusion feasible with Doppler sonography. The primary diagnosis has to be established histologically.

Hepatosplenic gamma‐delta T‐cell malignant lymphoma: report of the first case in childhood, including molecular minimal residual disease follow‐up

We report the first case of T-cell gamma delta+ hepatosplenic malignant lymphoma in childhood. Tumour-specific oligoprobes were developed against the single V1-J1 rearrangement of the delta T-cell receptor (TCR) gene in order to perform minimal residual disease (MRD) studies. Molecular analysis in serial bone marrow samples proved to be of predictive value concerning the clinical outcome. Clonotypic DNA was not detected in peripheral blood during the course of the disease until a refractory terminal leukaemic phase took place 18 months after the diagnosis. This case demonstrates the usefulness of MRD studies to monitor the course of disease in at least some subsets of peripheral T-cell lymphomas.

稀な経過をとった小児悪性リンパ腫の一例

A case of cutaneous malignant lymphoma in childhood with an interesting clinical course was reported. A 10-year-old boy visited our hospital complaining of right shoulder pain. A reddish swelling with baldness was found in the parietal region that had been injured with a thrown stone 2 years before the first visit. Left retroauricular lymphadenopathy was also noted. This had apparently one year after the head injury. Severe tenderness was seen on the right acromion, although there was no swelling nor any increase in temperature. The range of right shoulder motion was not limited.During the follow-up period, cryptogenetic arthritis was found in the left elbow, which was remarkably relieved by antibiotic therapy. Tumor formation was only recognized on the right acromion by magnetic resonance imaging. This tumor and the retroauricular lymph node were resected, and a bjopsy of the swelling in the parietal region was carried out. All three pathological specimens disclosed non-Hodgkin's lymphoma.

The Inhibition of Lymphocyte Blastogenesis by Asparaginase: Critical Role of Glutamine in both T and B Lymphocyte Transformation

L-Asparaginase has long been used in the treatment of acute lymphoblastic leukemia or malignant lymphoma in childhood. To determine cell type specific sensitivity to this drug, the L-asparaginase-mediated inhibition of blastogenesis of human peripheral T or B lymphocytes was compared. The rate of incorporation of [3H]-thymidine into the DNA of either T lymphocytes due to phytohemagglutinin (PHA) or B lymphocytes due to Staphylococcus aureus Cowan I (SAC) was measured by the addition of Escherichia coli L-asparaginase in the medium. The blastogenic response of either T or B lymphocytes was also determined in medium depleted of exogenous asparagine and/or glutamine, both of which are hydrolyzed by this enzyme. The in vitro blastogenesis of either human T lymphocytes due to PHA or B lymphocytes due to SAC was inhibited by the inclusion of asparaginase in the medium. The deprivation of exogenous asparagine did not have any inhibitory effect on the blastogenic response of both T and B lymphocytes to each mitogen. On the other hand, the glutamine concentration in the culture medium provided a critical influence on the proliferative response of T and B lymphocytes. The rate of incorporation of [3H]-thymidine into DNA was increased markedly as the concentration of glutamine was increased from 2(-7)-2 mmol/l. It is concluded that the mechanism of inhibition of PHA- or SAC-stimulated lymphocyte blastogenesis by L-asparaginase is not asparagine deprivation but glutamine deprivation. Glutamine, which is the most abundant amino acid, is thought to have an important role in the immune response of lymphocytes.

Cutaneous Malignant Lymphoma in Childhood

Cutaneous Malignant Lymphoma in Childhood

Treatment of Malignant Lymphoma in Childhood

Treatment of Malignant Lymphoma in Childhood

Treatment of Malignant Lymphoma in Childhood

Treatment of Malignant Lymphoma in Childhood

Malignant lymphoma in childhood.

Twenty-nine cases of malignant lymphoma in childhood excluding the leukaemic involvement, seen over a period from 1959 to 1971 have been reviewed. Males (82.8%) were more commonly affected than females (17.2%). One case of lymphosarcoma and four cases of reticulum cell sarcoma were extranodal in origin while ten, thirteen, and one case of lymphosarcoma, Hodgkin’s 3 disease and reticulum cell sarcoma respectively were of nodal origin. In the majority of cases, the age of onset was 2–4 years and 10–12 years in lymphosarcoma, 6–8 years in Hodgkin’s 3 disease and 10–14 years in reticulum cell sarcoma. The age of onset, clinical features and histological patterns have been discussed.

On the differential diagnosis of malignant lymphoma in childhood: Simultaneous manifestation of Hodgkin's disease and toxoplasmosis : I. Mutz, J. Zangger and W. Falk. Wien. Klin. Wschr. 81:917–920 (December), 1969

On the differential diagnosis of malignant lymphoma in childhood: Simultaneous manifestation of Hodgkin's disease and toxoplasmosis : I. Mutz, J. Zangger and W. Falk. Wien. Klin. Wschr. 81:917–920 (December), 1969

Primary gastrointestinal tract lymphoma in childhood.

We have recently reviewed the experience of the Hospital for Sick Children, Toronto, The Princess Margaret Hospital, and the Department of Radiotherapy, Toronto General Hospital, with malignant lymphoma in childhood (patients less than 16 years of age at time of diagnosis) (1, 2). Of 196 children who presented in the years 1930 to 1965, 75 had Hodgkin's disease, and 121 had lymphosarcoma, reticulum-cell sarcoma, or other malignant lymphoma. In Hodgkin's disease no child presented with the primary site in the gastrointestinal tract, but of the 121 children with other malignant lymphomas (Table I) 56 presented with abdominal symptoms and signs. Of these, 55 required a laparotomy to establish the diagnosis. The laparotomy findings in 40 cases indicated the primary site of origin to be gut. In one instance the lesion has been reclassified as pseudolymphoma of the small intestine (3). Ten of the remaining 39 cases have previously been reviewed (4). We present this analysis because a marked improvement in survival is apparent in our recent experience with this uncommon and usually fatal tumor. Clinical Data (a) Age and Sex: The age distribution is seen in Figure 1. There is a peak incidence in the age range of 5 to 8 years. Boys outnumbered girls in a ratio of 9:1. The age distribution of the survivors follows the incidence pattern. (b) Mode of Presentation: These children presented with abdominal pain and vomiting, most often as episodes of small bowel obstruction of greater or less degree. In over half of the cases a definite mass was palpable in mid or right abdomen. Fifteen children presented with intussusception and one with a perforated viscus. The diagnosis of primary malignant lymphoma of gut is not easily made preoperatively. Eight of our children had had prior surgery, 2 for reduction of an intussusception and 6 on a diagnosis of appendicitis or appendiceal abscess, without the lymphomatous nature of their disease being appreciated. (c) Stage at Diagnosis—Early Stage: In 20 children the laparotomy findings indicated that the lymphoma was limited to a segment of gut plus or minus the associated mesenteric nodes only. This group is defined as having “early stage” disease. Late Stage: In 19 children the disease was more extensive. Most often, spread was to the para-aortic and retroperitoneal nodes by implants and plaques in mesentery or peritoneum, or by direct infiltration of structures adjacent to the primary tumor. In all these children the primary involvement of gut dominated the clinical picture at laparotomy. This group of patients is defined as having “late stage” disease. (d) Primary Site: In 35 of the 39 children the primary site was in the lower ileum, cecum, appendix, ascending colon, or some combination of these sites (Table II). Treatment (a) Surgery: The diagnosis is made at laparotomy, often for an acute abdomen at a time when malignant tumor is not anticipated.