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Klin Padiatr 2012; 224(06): 377-381
DOI: 10.1055/s-0032-1323824
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of the Prognostic Meaning of C-reactive Protein (CRP) in Children and Adolescents with Classical Hodgkin’s Lymphoma (HL)

Die prognostische Bedeutung des C-reaktiven Proteins bei Kindern und Jugendlichen mit klassischem Hodgkin Lymphom (HL)
R. Haase
1   Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle Wittenberg, Halle/Saale, Germany
,
C. Vilser
1   Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle Wittenberg, Halle/Saale, Germany
,
C. Mauz-Körholz
1   Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle Wittenberg, Halle/Saale, Germany
,
D. Hasenclever
2   Institut für Medizinische Informatik, Statistik & Epidemiologie (IMISE), Universität Leipzig, Leipzig, Germany
,
R. Kluge
3   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
,
K. Ruschke
4   Klinik für Radiologie, Halle/Saale, Martin-Luther-Universität Halle Wittenberg, Germany
,
A. Borkhardt
5   Zentrum für Kinder- und Jugendmedizin, Universität Düsseldorf, Düsseldorf, Germany
,
K. Seeger
6   Klinik für Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charite Universitätsmedizin Berlin, Berlin, Germany
,
T. Lehrnbecher
7   Zentrum für Kinder- und Jugendmedizin, Klinik III, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt, Germany
,
A. Kulozik
8   Kinderklinik III: Päd. Onkologie, Hämatologie und Immunologie, Heidelberg, Universitätsklinikum Heidelberg, Germany
,
J. Rößler
9   Klinik IV: Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Freiburg, ZKJ, Freiburg, Germany
,
S. Burdach
10   Kinderklinik München Schwabing, München, Technische Universität München, Germany
,
H. Jürgens
11   Pädiatrische Hämatologie und Onkologie, Univ.-Klinikum Münster, Klinik für Kinder- und Jugendmedizin, Münster, Germany
,
D. Körholz
1   Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle Wittenberg, Halle/Saale, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
09 October 2012 (online)

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Abstract

Background:

In adult cancer patients the negative predictive value of elevated CRP levels has been described for several malignancies. Only few studies have analyzed the prognostic role of CRP in children and adolescents with classical HL. In these studies elevated CRP levels correlate with the presence of classical risk factors and adverse outcome.

Patients and methods:

The prognostic role of CRP for patients with classical HL admitted to the GPOH-HD-2002 study was analyzed retrospectively.

Results:

CRP levels were documented for 369 of 573 patients. Significant (p<0.05) increased median CRP levels were found in the presence of B-Symptoms (25.7 vs. 5.1 mg/l), extranodal involvement (21.5 vs. 7.5 mg/l), elevated erythrocyte sedimentation rate (ESR, 13.0 vs. 1.0 mg/l) and stage III/IV disease (15.5 vs. 5.3 mg/l). 83.9% of patients with elevated and 45.8% of patients with normal CRP had an ESR >30 mm/h.

Conclusion:

Elevated CRP levels were associated with classical risk factors of HL. CRP and ESR may reflect different biological processes. CRP was prognostic within early stage TG-1 patients treated with reduced treatment, but not within advanced stage TG-2+3.

Zusammenfassung

Hintergrund:

Das C- reaktive Protein (CRP) wurde bei einer Vielzahl von malignen Erkrankungen des Erwachsenenalters als Risikofaktor beschrieben. Hinsichtlich des HL im Kindes- und Jugendalter existieren zur prognostischen Wertigkeit des CRP nur wenige Daten. Diese zeigen eine Korrelation von erhöhtem CRP und ungünstiger Prognose bzw. dem Vorliegen klassischer Risikofaktoren.

Patienten und Methoden:

In der vorliegenden Arbeit analysierten wir retrospektiv die prognostische Bedeutung des CRP für im Rahmen der GPOH-HD-2002 Studie behandelte Kinder und Jugendliche mit klassischem HL.

Ergebnisse:

CRP Werte waren für 369 von 573 Patienten verfügbar. Signifikant (p<0,05) erhöhte mediane CRP Werte fanden sich bei Vorliegen von B-Symptomen (25,7 vs. 5,1 mg/l), einer Blutsenkungsgeschwindigkeit >30 mm/h (13,0 vs. 1,0 mg/l), extranodalem Befall (21,5 vs. 7,5 mg/l) und Stadium III/IV (15,5 vs. 5,3 mg/l). 83,9% der Patienten mit erhöhtem und 45,8% der Patienten mit normalen CRP hatten eine BSG >30 mm/h. In der Therapiegruppe (TG) 1, nicht aber in TG 2 und 3 hatten Patienten mit initial erhöhtem CRP ein höheres Risiko für negatives outcome (Progression/Rezidiv oder Tod).

Schlussfolgerung:

In der analysierten Patientengruppe korreliert das CRP mit klassischen Risikofaktoren des HL. Die Entzündungsparameter CRP und BSG sind hinsichtlich der Prognoseabschätzung nicht austauschbar. Eine prognostische Bedeutung des CRP ließ sich nur für die TG 1 mit relativ geringer Therapieintensität nachweisen.

Key words

hodgkin’s lymphoma - c-reactive protein - prognosis - risk factor - GPOH-HD-2002 study

Schlüsselwörter

Hodgkin Lymphom - C-reaktives Protein - Prognose - Risikofaktor - GPOH-HD-2002 Studie
 

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