CK Li, MK Shing, KW Chik, H Lai, CK Yeung, PMP Yuen

Non-Hodgkin Lymphoma (NHL) is the third commonest childhood malignancy. From January 1985 to August 1995, 21 cases of NHL were diagnosed and treated in Department of Paediatrics, Prince of Wales Hospital. A retrospective analysis of the clinical features, treatment and outcome of these cases was done. The male to female ratio was 2:1. The median age at diagnosis was 8.5 years (range 1.3 to 15 year). Histological classification according to Working Formulation classified NHL into 3 main groups: (1) Lymphoblastic (LB) (n=6), (2) Small non-cleaved cell (SNCC) (n=11), (3) Large cell (LC) (n=4). LB NHL were all T cell immunophenotype; SNCC NHL were B cell with Burkitt's subtype; where as LC NHL were T cell or Ki- 1 positive, or null cell. Staging of NHL was made according to St. Jude (NHL) system. 4 of 6 LB NHL were boys older than 9 years with stage III mediastinal mass, and presented as SVC obstruction. The other 2 LB NHL presented as urinary obstruction and mass over right arm; both were stage IV. 9 of 11 SNCC NHL presented as intra-abdominal mass causing abdominal pain, intussusception, or obstructive jaundice. The other 2 presented with hoarse voice due to tonsillar mass, and cervical lymphadenopathy. The staging of SNCC NHL were 2 stage II, 7 stage III and 2 stage IV. The presentations of LC NHL were more variable: Bone lesion, cervical lymphadenopathy and subcutaneous mass. Diagnosis was made by LN or percutaneous tissue biopsy (8), laparotomy or exploration (9), bone marrow examination (1), excisional biopsy of the mass (3). Primary intention of complete resection of tumour could only be achieved in 1 patient. All patients were treated with chemotherapy: LB NHL by LSA₂L₂ or ALL protocol, SNCC NHL by COMP in 73% of patients, LC NHL by various protocol. 16 patients were in remission and 1 patient lost follow up after 1.5 year in complete remission. The overall survival was 80% at the median follow up of 6.5 years (2 months to 10.5 years). According to histological subtypes, the disease free survival (DFS) for SNCC NHL is 72% at median follow up of 7.8 years (4-10.5 years); DFS for LB NHL is 80% at median follow up 4 years (1.8-5.4 years); DFS for LC NHL is 100% with follow up between 2 months to 7.5 years. 3 patients died of relapse and 1 patient died of complication of treatment.

Conclusion With modern chemotherapy, a high cure rate for childhood NHL can be achieved.