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Home    Λεμφώματα Hodgkin και non Hodgkin σε παιδιά, εφήβους και νεαρούς ενήλικες. Νεότερα δεδομένα στην ταξινόμηση και θεραπεία και αποτύπωση εμπειρίας 25 ετών στην Κλινική Αιματολογίας-Ογκολογίας Παίδων ΠαΓΝΗ  

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Identifier 000449927
Title Λεμφώματα Hodgkin και non Hodgkin σε παιδιά, εφήβους και νεαρούς ενήλικες. Νεότερα δεδομένα στην ταξινόμηση και θεραπεία και αποτύπωση εμπειρίας 25 ετών στην Κλινική Αιματολογίας-Ογκολογίας Παίδων ΠαΓΝΗ
Alternative Title Hodgkin and non Hodgkin lymphomas in children, adolescents and young adults. Newest developments in classification and therapy and assessment of a 25-year old experience in the Pediatric Hematology-Oncology department of University General Hospital of Heraklion
Author Κοντογιάννη, Παναγιώτα
Thesis advisor Στειακάκη, Ευτυχία
Reviewer Καλπαδάκη, Χριστίνα
Δράκος, Ηλίας
Abstract Introduction: Lymphomas represent the 3rd most common malignancy in childhood, after Acute lymphoblastic leukemia and tumors of the central nervous system (prevalence 12-16%). They are developed from malignant transformation of lymphoid cells. There are two main clinicopathological types of lymphomas, the Hodgkin and non Hodgkin lymphomas, each one having their one subtypes. Recently, the World Health Organization (2016) published the newest developments in classification of lymphomas, including the pediatric type of follicular lymphoma. For the appropriate treatment of lymphomas, staging is necessary. In the past, the medical history, clinical examination, bone marrow biopsy, some laboratory markers and classic imaging techniques such as X-ray, ultrasound, computed tomography and bone scan were the only tools available for staging of lymphomas. Nowadays, the use of Positron emission tomography- PET/CT is necessary for the diagnosis and for the assessment of treatment response as well. The Ann-Arbor staging system of Hodgkin lymphoma has been revised including the PET/CT (Lugano classification system) and the response to treatment is currently evaluated with the Deauville score after 2 cycles of chemotherapy. The target of cooperative groups such as EuroNET-PHL is to reduce the dose or to omit radiotherapy from the therapeutic protocols , replace chemotherapy drugs with less toxic alternatives, intensify or de-escalate therapy according to the early response to treatment. Additionally, in clinical trials, new target drugs such as Βrentuximab vedotin (anti-CD30 monoclonal antibody combined with chemotherapeutic drug) and Nivolumab (PD1 inhibitor) are being tested for their safety and efficacy in pediatric patients newly diagnosed or relapsed. The Saint Jude staging system for non Hodgkin lymphomas has been updated, recognizing the often participation of organs such as the skin, the ovaries, the bones and the kidneys and including new more reliable methods for detection of CNS or bone marrow involvement. The new international revised classification system for pediatric non Hodgkin lymphomas is called IPNHLSS and its goal is to aid in comparison of efficacy between different therapeutic protocols from international centers and cooperative groups. Each subtype of NHL follows different therapeutic protocol while pathologic and genomics differences between pediatric and adult lymphomas and the rarity of some subtypes make the incorporation of evolutionary adult drugs into the pediatric population difficult. Nevertheless, clinical trials are on the way for the incorporation of new monoclonal antibodies such as obinutuzumab or inhibitors of signaling pathways such as the inhibitor of ALK tyrosine kinase, crizotinib. The goal is to replace classic chemotherapy drugs which have many acute and late adverse effects such as gonadotoxicity, cardiotoxicity and secondary malignancies. Aim: The aim of this research is to summarize the published data on paediatric, adolescents’ and young adults’ lymphomas concerning their classification and treatment. Additionally, another target of this research is the retrospective study of the lymphoma cases diagnosed and treated in the Pediatric Hematology-Oncology department of University General Hospital of Heraklion in the last 25 years as well as the comparison between older and newer therapeutic approaches and the compliance with the international newest developments. Materials and methods: This particular study consists of a bibliographic review of lymphomas and a record of the cases in the Pediatric Hematology-Oncology department of University General Hospital of Heraklion in the last 25 years. In each case parameters such as demographic information, pathologic report, existence of B symptoms, stage, imaging studies on diagnosis, cytogenic characteristics of the lymphoma, blood results, type of treatment, protocol of chemotherapy, occurrence of relapse were obtained. All this information was carefully collected from the medical files of the patients and was submitted to statistic analysis. Results: The 25-year old record of the lymphoma cases concluded in the collection of 60 patients. 38 of them were diagnosed with Hodgkin lymphoma and 22 with non Hodgkin lymphoma with a mean age of 13.4 years old (± 4.3 years). All patients were treated according to international well recognized protocols, 8 patients relapsed and none of them died. The majority of patients are being followed regularly for late adverse effects in the Pediatric or Adult department of Hematology-Oncology. Conclusion: Despite the fact that this study derives information from one medical centre with low number of registered patients and the inability to export statistical important information, the compliance with the international guidelines of classification and treatment of lymphomas is clear. The continuation of this record in the future will extract more useful information since it will include more patients and it will take into account new target drugs in the therapy of lymphomas.
Language Greek
Subject Target therapies
Θεραπευτική αντιμετώπιση
Στοχευμένες θεραπείες
Issue date 2022-07-29
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
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