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Differentiation between rebound thymic hyperplasia and thymic relapse after chemotherapy in pediatric Hodgkin lymphoma
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  • Dietrich Stovesandt,
  • Friedrich Christian Franke,
  • Adrian Damek,
  • Jonas Steglich,
  • Lars Kurch,
  • Dirk Hasenclever,
  • Thomas Georgi,
  • Walter Wohlgemuth,
  • Christine Mauz-Koerholz,
  • Dieter Körholz,
  • Regine Kluge,
  • Judith Landman-Parker,
  • William Hamish Wallace,
  • Alexander Fosså,
  • Dirk Vordermark,
  • Jonas Karlen,
  • Ana Fernández-Teijeiro,
  • Michaela Cepelova,
  • Tomasz Klekawka,
  • Andishe Attarbaschi,
  • Francesco Ceppi,
  • Andrea Hraskova,
  • Anne Uyttebroeck,
  • Auke Beishuizen,
  • Karin Dieckmann,
  • Thierry Leblanc,
  • Martin Moellers,
  • Boris Buerke
Dietrich Stovesandt
Universitatsklinikum Halle

Corresponding Author:[email protected]

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Friedrich Christian Franke
Universitatsklinikum Halle
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Adrian Damek
Universitatsklinikum Halle
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Jonas Steglich
Universitatsklinikum Halle
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Lars Kurch
Universitat Leipzig Medizinische Fakultat
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Dirk Hasenclever
Universitat Leipzig Medizinische Fakultat
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Thomas Georgi
Universitat Leipzig Medizinische Fakultat
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Walter Wohlgemuth
Universitatsklinikum Halle
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Christine Mauz-Koerholz
Justus Liebig Universitat Giessen Fachbereich Medizin
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Dieter Körholz
Justus Liebig Universitat Giessen Fachbereich Medizin
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Regine Kluge
Universitat Leipzig Medizinische Fakultat
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Judith Landman-Parker
Sorbonne Universite
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William Hamish Wallace
The University of Edinburgh
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Alexander Fosså
Oslo Universitetssykehus
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Dirk Vordermark
Universitatsklinikum Halle
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Jonas Karlen
Karolinska Universitetssjukhuset
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Ana Fernández-Teijeiro
Hospital Universitario Virgen Macarena
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Michaela Cepelova
Department of Pediatric Hematology and Oncology University Hospital Motol and Second Medical Faculty of Charles University Prague Czech Republic
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Tomasz Klekawka
Pediatric Oncology and Hematology Department University Children's Hospital of Krakow Krakow Poland
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Andishe Attarbaschi
Medizinische Universitat Wien
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Francesco Ceppi
Universite de Lausanne
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Andrea Hraskova
Department of Pediatric Hematology and Oncology National Institute of Paediatric Diseases Bratislava Slovakia
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Anne Uyttebroeck
Department of Pediatric Hematology and Oncology University Hospitals Leuven Leuven Belgium
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Auke Beishuizen
Erasmus MC–Sophia Children’s Hospital Rotterdam The Netherlands
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Karin Dieckmann
Department of Radiation Oncology University Hospital Vienna Vienna Austria
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Thierry Leblanc
Service d’Hématologie Pédiatrique Hôpital Robert-Debré Paris France
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Martin Moellers
Department Department of Pediatric Radiology University Bielefeld Campus Bielefeld-Bethel Bielefeld Germany
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Boris Buerke
Universitatsklinikum Munster
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Abstract

Background Rebound thymic hyperplasia (RTH) is a common phenomenon caused by stress factors such as chemo- (CTX) or radiotherapy with an incidence of up to 40%. Misinterpretation of RTH and thymic lymphoma relapse (LR) may lead to unnecessary diagnostic procedures including invasive biopsies or treatment intensification. The aim of this study was to identify parameters that differentiate between RTH and thymic LR in the anterior mediastinum. Methods After completion of CTX, we analyzed CTs and MRIs of 291 patients with classical Hodgkin lymphoma (CHL) and adequate imaging available from the European Network for Pediatric Hodgkin lymphoma C1-trial. In all patients with biopsy proven LR an additional FDG-PET-CT was assessed. Structure and morphologic configuration in addition to calcifications and presence of multiple masses in the thymic region and signs of extrathymic LR were evaluated. Results After CTX, a significant volume increase of a new or growing mass in the thymic space occurred in 133 of 291 patients. Without biopsy only 100 patients could be identified as RTH or LR. No single finding related to thymic regrowth allowed differentiation between RTH and LR. However, the vast majority of cases with thymic LR presented with additional increasing tumor masses (34/35). All RTH patients (65/65) presented with isolated thymic growth. Conclusion Isolated thymic LR is very uncommon. CHL relapse should be suspected when increasing tumor masses are present in distant sites outside of the thymic area. Conversely, if regrowth of lymphoma in other sites can be excluded, an isolated thymic mass after CTX likely represents RTH.
12 Aug 2022Submitted to Pediatric Blood & Cancer
12 Aug 2022Submission Checks Completed
12 Aug 2022Assigned to Editor
13 Oct 2022Reviewer(s) Assigned
09 Nov 2022Review(s) Completed, Editorial Evaluation Pending
09 Nov 2022Editorial Decision: Revise Major
27 Jan 2023Submission Checks Completed
27 Jan 2023Assigned to Editor
27 Jan 20231st Revision Received
27 Mar 2023Review(s) Completed, Editorial Evaluation Pending
27 Mar 2023Reviewer(s) Assigned
14 Apr 2023Editorial Decision: Revise Minor
23 Apr 2023Submission Checks Completed
23 Apr 2023Assigned to Editor
23 Apr 20232nd Revision Received
28 Apr 2023Review(s) Completed, Editorial Evaluation Pending
28 Apr 2023Editorial Decision: Accept