Laparoscopy and laparotomy combined with bone marrow biopsy in staging Hodgkin's disease.

The relative merits of laparoscopy with liver and spleen biopsy and staging laparotomy were studied in 91 unselected patients with Hodgkin''s disease. Laparoscopy with liver and spleen biopsy were combined with needle biopsy of the bone marrow and laparotomy was combined with open bone marrow biopsy. In 65 untreated patients six out of seven with liver or marrow disease, or both, were shown to have extranodal lymphomas in these sites by laparoscopy plus needle marrow biopsy. Among 26 patients who had been treated this finding occurred in six out of 10 patients. Spleen biopsies during laparoscopy detected infiltration by lymphoma in 14 out of 37 (38%) patients with diseases spleens. Morbidity was higher after laparotomy than after laparoscopy. Laparoscopy produced abdominal bleeding secondary to splenic biopsy in two patients. All patients with Hodgkin''s disease should be subjected to laparoscopy plus needle marrow biopsy before undergoing laparotomy.     

Long-term follow-up after relapses in children with Hodgkin's disease

In the years 1969-1980, 68 children with Hodgkin's disease were subjected to a combined MVPP and radiotherapy. Remissions were obtained in 64 patients, and relapses occurred in 11 children. The treatment of relapse consisted in administration of B-DOPA alone or alternatively with MVPP combined with radiotherapy (in 7 out of 11 patients). The patients were recycled every 2-3 weeks which, with other modifications of chemotherapy, allowed for the completion of the six first cycles within the period of 4,5 to 7 months. A relapse caused death of one child, and two others demonstrated further relapses. At present eight children have been showing disease-free survival following a relapse for the period of 29+ to 152+ (median, 94.5 months). The authors concluded that in patients with relapses of Hodgkin's disease the decisive role rests upon aggressive chemotherapy (high frequency of cycles).     

Secondary neoplasms in two children with Hodgkin's disease]

In two out of 59 children with Hodgkin's disease treated with MVPP regimen combined with local irradiation and followed up over 10 years the secondary neoplasms were detected, i.e. in 3.4% with persisting remission of the underlying disease. Chondrosarcoma was diagnosed in one patient in the field of irradiation (after 13 years). This patient died. In the second patient two different tumors (squamous epithelioma and fibrosarcoma) developed after 7 and 9 years following irradiation of two different areas. Actually, there are not any symptoms in this female patients (working). To decrease the incidence of these serious complications of Hodgkin's disease treatment regimens introduced by the Polish Pediatric Leukemia Study Group since 1988, the use of alkylating agents in limited, and the dose of local irradiation is decreased.     

Treatment failures and severe complications in children with Hodgkin's disease

Therapy failures and severe complications in the treatment of 46 children affected with Hodgkin's disease are reported. All children were treated with polychemotherapy (modified MVPP scheme) and radiotherapy (high voltage therapy X-ray 210 KV; involved field radiotherapy). 42 patients came into a complete remission, with a median of 58 months in 37 patients (10--97 months). 6 patients 14.3%) suffered from a recidive, 5 of them came into a second remission. Life-threatening infections appeared in 3 patients. After 9 MVPP cycles an encephalopathy appeared in 2 boys, one of them died. After local radiotherapy a severe laryngitis developed in two patients. An azoospermia existed in 6 adolescent boys examined.     

Changes in immune status in patients undergoing splenectomy for the staging of Hodgkin's disease.

The immune status of 17 patients with Hodgkin''s disease was studied before and after splenectomy (undertaken in staging laparotomy) and during chemotherapy or after radiotherapy. The findings were compared with those in 19 patients not selected for splenectomy. Serum IgA and IgM levels became significantly lower after treatment in the splenectomy group. Cell-mediated immunity was depressed mainly in patients receiving quadruple cytotoxic chemotherapy. Neutrophil function was normal or enhanced and was unchanged after splenectomy and treatment despite changes in neutrophil counts. Three patients who underwent splenectomy suffered fatal septicaemia. These results suggest that humoral immunity is depressed by treatment in patients who have undergon splenectomy, and the benefits of early accurate staging must be weighed against the likelihood of infective complications.