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Abstract：
OBJECTIVE: ABVD (doxorubicin, bleomycin,vinblastine, and dacarbazine) is not a standard regimen in children due to concerns regarding late effects. However, no studies have evaluated long-term toxicities of ABVD in children.
METHODS: Total 154 pediatric Hodgkin lymphoma (HL) survivors uniformly treated with ABVD were clinically followed up as per institutional protocol. All participants were evaluated for cardiac, pulmonary, and thyroid function abnormalities by multigated acquisition scan (MUGA) scan, spirometry with diffusion capacity of lung for the uptake of carbon monoxide (DLCO), and thyroid profile test, respectively, at a single time point. Predictors of toxicity were also analyzed.
RESULTS: The median duration of follow-up of the cohort was 10.3 years (6.04-16.8). No secondary malignant neoplasm (SMN) or symptomatic cardiac/pulmonary toxicities were detected. Nine patients (5.9%) had left ventricular ejection fraction (LVEF) <55%. Subclinical and overt hypothyroidism were observed in 78 (50.6%) and 16 (10.4%) survivors, respectively. Abnormal spirometry and reduced DLCO was observed in 43.2% and 42.0% survivors, respectively. Receiving neck radiation was significantly associated with thyroid dysfunction (odds ratio [OR] 16.04, p < .001); age ≥10 years predicted reduced DLCO (OR 4.12, p = .001). Sixty-three and 33 patients had one and two late adverse effects, respectively; receiving neck radiation predicted development of multiple late effects (proportional OR 4.72, p < 0.001). Cumulative dose of chemotherapy did not predict toxicity.
CONCLUSIONS: Overall, ABVD appears safe in children at a relatively short follow-up. Long-term safety data are required before it can be adopted for treating pediatric HL patients. Children receiving neck radiation require close follow-up.
METHODS: Total 154 pediatric Hodgkin lymphoma (HL) survivors uniformly treated with ABVD were clinically followed up as per institutional protocol. All participants were evaluated for cardiac, pulmonary, and thyroid function abnormalities by multigated acquisition scan (MUGA) scan, spirometry with diffusion capacity of lung for the uptake of carbon monoxide (DLCO), and thyroid profile test, respectively, at a single time point. Predictors of toxicity were also analyzed.
RESULTS: The median duration of follow-up of the cohort was 10.3 years (6.04-16.8). No secondary malignant neoplasm (SMN) or symptomatic cardiac/pulmonary toxicities were detected. Nine patients (5.9%) had left ventricular ejection fraction (LVEF) <55%. Subclinical and overt hypothyroidism were observed in 78 (50.6%) and 16 (10.4%) survivors, respectively. Abnormal spirometry and reduced DLCO was observed in 43.2% and 42.0% survivors, respectively. Receiving neck radiation was significantly associated with thyroid dysfunction (odds ratio [OR] 16.04, p < .001); age ≥10 years predicted reduced DLCO (OR 4.12, p = .001). Sixty-three and 33 patients had one and two late adverse effects, respectively; receiving neck radiation predicted development of multiple late effects (proportional OR 4.72, p < 0.001). Cumulative dose of chemotherapy did not predict toxicity.
CONCLUSIONS: Overall, ABVD appears safe in children at a relatively short follow-up. Long-term safety data are required before it can be adopted for treating pediatric HL patients. Children receiving neck radiation require close follow-up.
摘要：
目标：ABVD（阿霉素，博来霉素,长春碱,和dacarbazine）不是儿童的标准方案，因为担心后期效果。然而,尚无研究评估儿童ABVD的长期毒性.
方法：根据机构方案，对统一接受ABVD治疗的154名小儿霍奇金淋巴瘤（HL）幸存者进行了临床随访。所有参与者都接受了心脏评估，肺,和甲状腺功能异常通过多门控采集扫描（MUGA）扫描，肺活量测定与肺的扩散能力吸收一氧化碳（DLCO），和甲状腺轮廓测试，分别,在一个时间点。还分析了毒性的预测因子。
结果：队列的中位随访时间为10.3年（6.04-16.8）。未检测到继发性恶性肿瘤（SMN）或有症状的心脏/肺毒性。9例(5.9%)患者左心室射血分数(LVEF)<55%。在78例（50.6%）和16例（10.4%）幸存者中观察到亚临床和明显的甲状腺功能减退症，分别。在43.2％和42.0％的幸存者中观察到肺活量异常和DLCO减少，分别。接受颈部辐射与甲状腺功能障碍显着相关（比值比[OR]16.04，p<.001）；年龄≥10岁可降低DLCO（OR4.12，p=.001）。63例和33例患者有1例和2例晚期不良反应,分别；接受颈部辐射预测多个晚期效应的发展(比例OR4.72，p<0.001)。化疗的累积剂量不能预测毒性。
结论：总体而言，在相对较短的随访中，儿童ABVD似乎是安全的。需要长期安全性数据才能用于治疗小儿HL患者。接受颈部辐射的儿童需要密切随访。
方法：根据机构方案，对统一接受ABVD治疗的154名小儿霍奇金淋巴瘤（HL）幸存者进行了临床随访。所有参与者都接受了心脏评估，肺,和甲状腺功能异常通过多门控采集扫描（MUGA）扫描，肺活量测定与肺的扩散能力吸收一氧化碳（DLCO），和甲状腺轮廓测试，分别,在一个时间点。还分析了毒性的预测因子。
结果：队列的中位随访时间为10.3年（6.04-16.8）。未检测到继发性恶性肿瘤（SMN）或有症状的心脏/肺毒性。9例(5.9%)患者左心室射血分数(LVEF)<55%。在78例（50.6%）和16例（10.4%）幸存者中观察到亚临床和明显的甲状腺功能减退症，分别。在43.2％和42.0％的幸存者中观察到肺活量异常和DLCO减少，分别。接受颈部辐射与甲状腺功能障碍显着相关（比值比[OR]16.04，p<.001）；年龄≥10岁可降低DLCO（OR4.12，p=.001）。63例和33例患者有1例和2例晚期不良反应,分别；接受颈部辐射预测多个晚期效应的发展(比例OR4.72，p<0.001)。化疗的累积剂量不能预测毒性。
结论：总体而言，在相对较短的随访中，儿童ABVD似乎是安全的。需要长期安全性数据才能用于治疗小儿HL患者。接受颈部辐射的儿童需要密切随访。
