Response-Based Approach for Pediatric Hodgkin Lymphoma in Nations with Restricted Resources
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Abstract
Background: Hodgkin lymphoma (HL) management varies throughout developing nations. This observational study aims to present the results of children having HL who received various combinations of chemotherapy treatment. The response-based method was used regardless of the risk classification.
Materials and Methods: We recruited patients≤ 18 years of age diagnosed with HL in an Iraqi cancer center between January 2014 and December 2021. By stratifying patients, three risk categories were identified. Every patient initially received two cycles of ABVD as induction chemotherapy. Following induction chemotherapy, patients showing a full radiological response continued on ABVD chemotherapy for 4-6 cycles without receiving radiotherapy. Patients showing a modest initial response received three additional courses of COPDac next to the third cycle of ABVD, followed by radiotherapy.
Results: This study included fifty-nine patients with a median age of 7 years. Stage III patients accounted for 33.9% (n=20), then stage II (32.2%). B symptoms were present in 25 patients. Eleven children had initial splenic involvement. Fifty-two individuals (n = 19; 32.2%) had bulky disease. Mixed cellularity was the most prevalent histology (n=44). The median duration of follow-up was 2.7 years. EFS was 78% ±10%, and survival was 92% at 5-year estimation. Bulky disease was the only factor with a substantial unfavorable impact on the result.
Conclusion: Response-based approach is a valuable strategy in nations with limited resources to prevent long-term sequelae from unnecessary radiotherapy.
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2. Ketchen D. Epidemiology and Treatment Outcome of Lymphomas in Children: A Study From a Developing Area in Cameroon. J Glob Oncol. 2018;4(Supplement 2).
3. Kebudi R, Buyukkapu SB, Gorgun O , et al. Risk adapted treatment in childhood Hodgkin’s lymphoma: Outcome and changing epidemiologic features in 25 years. Blood. 2016;128(22):4158.
4. Radhakrishnan V, Dhanushkodi M, Ganesan TS, et al. Pediatric Hodgkin lymphoma treated at Cancer Institute, Chennai, India: Long-term outcome. J Glob Oncol. 2017;3(5): 545–554.
5. Riaz S, Khan S, Badar F. Pediatric Hodgkin’s Lymphoma: 5-Year Experience at Single Center in Pakistan. Blood. 2014;124(21):5455.
6. Buch N, Mehta P, Bafna V, et al. Abandonment of therapy and consequent loss to follow up is related to disease prognosis. Experience of a tertiary care center in a developing country. Pediatr Blood Cancer. 2009;53(5):701-915.
7. Stanley CC, van der Gronde T, Westmoreland KD, et al. Risk factors and reasons for treatment abandonment among children with lymphoma in Malawi. Support Care Cancer. 2018;26(3):967-973.
8. Diagne, F. B., Moreira, C., Diouf, N., Edan, C., Raquin, M. A., & Patte, C. (2015, November). Pediatric Hodgkin lymphoma treatment with chemotherapy alone: FRENCH-AFRICAN pediatric oncology group (GFAOP) experience. In pediatric blood & cancer (Vol. 62, pp. S147-S147). 111 river st, hoboken 07030-5774, NJ USA: Wiley-Blackwell.
9. Ngoc Lan B, Castor A, Wiebe T, et al. Adherence to childhood cancer treatment: A prospective cohort study from Northern Vietnam. BMJ Open. 2019;9(8): e026863.
10. Jadhav A, Dhingra H, Kalra M, et al. Treatment refusal and abandonment in childhood cancer at a tertiary care center in North India. Pediatr Hematol Oncol J. 2017;2(2):S10.
11. Kelly KM, Cole PD, Pei Q, et al. Response-adapted therapy for the treatment of children with newly diagnosed high-risk Hodgkin lymphoma (AHOD0831): a report from the Children’s Oncology Group. Br J Haematol. 2019;187(1):39-48.
12. Jhawar SR, Rivera-Núñez Z, Drachtman R, et al. Association of Combined Modality Therapy vs Chemotherapy Alone with Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma. JAMA Oncol. 2019;5(5):689-695.
13. Hudson MM, Krasin M, Link MP, et al. Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin’s disease. J Clin Oncol. 2004;22(22): 4541-50.
14. Schellong G, Pötter R, Brämswig J, et al. High cure rates and reduced long-term toxicity in pediatric Hodgkin’s disease: The German-Austrian multicenter trial DAL-HD-90. J Clin Oncol. 1999;17(12):3736-44.
15. Weiner M, Leventhalt B, Brecher M, et al. Randomized study of intensive MOPP-ABVD with or without low-dose total-nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB and IV Hodgkin’s disease in pediatric patients: a pediatric oncology group study. J Clin Oncol. 1997;15(8):2769-79.
16. McCarten KM, Nadel H R, Shulkin BL, et al. Imaging for diagnosis, staging and response assessment of Hodgkin lymphoma and non-Hodgkin lymphoma. Pediatr Radiol. 2019; 49(11):1545-1564.
17. Fernández KS, Schwartz CL, Chen L, et al. Outcome of adolescents and young adults compared to children with Hodgkin lymphoma treated with response-based chemotherapy on pediatric protocols: A Children’s Oncology Group report. Pediatr Blood Cancer. 2017;64(12):10.1002/pbc.26681.
18. Khedr R, Hamouda A, Naguib S, et al. Prognostic Value of Interim Positron Emission Tomography Among Children with Advanced Hodgkin Lymphoma in Developing Countries: Children Cancer Hospital Egypt Experience. Blood. 2016;128(22):4156.
19. Veron DA, Streitenberger P, Riccheri C, et al. Risk-Adapted Therapy with ABVD for Low- and Intermediate-Risk Patients and Oepa-Copdac for High Risk Patients Plus Involved-Field Radiation Therapy (IFRT) Based on Prognosis at Diagnosis and Early Response: Results from Pediatric Argentinian Collaborative Group Gatla Study for Children and Adolescents with Hodgkin Lymphoma. Blood. 2020;136(Supplement 1):13.
20. Fadoo Z, Belgaumi A, Alam M, et al. Pediatric lymphoma: A 10-year experience at a tertiary care hospital in Pakistan. J Pediatr Hematol Oncol. 2010;32(1):e14-8.
21. Hamadeh RR, Armenian HK, Zurayk HC. A study of clustering of cases of leukemia, Hodgkin’s disease and other lymphoma’s in Bahrain. Trop Geogr Med. 1981;33(1):42-48.
22. Ritter AJ, Goldstein JS, Ayers AA, et al. Rural and urban patients with diffuse large B-cell and follicular lymphoma experience reduced overall survival: a National Cancer DataBase study. Leuk Lymphoma. 2019;60(7):1656-1667.
23. Blansky D, Mantzaris I, Rohan T, et al. Influence of Rurality, Race, and Ethnicity on Non-Hodgkin Lymphoma Incidence. Clin Lymphoma, Myeloma Leuk. 2020;20(10):668-676.e5.
24. Sherief LM , Elsafy UR, Abdelkhalek ER, et al. Hodgkin lymphoma in childhood: clinicopathological features and therapy outcome at 2 centers from a developing country. Medicine (Baltimore). 2015;94(15):e670.
25. Memon W, Samad A, Sheikh GM. Hodgkin's lymphoma in cervical lymphadenopathy. Pakistan J Med Sci. 2008;24(1):118-121.
26. Ghafoor T. Prognostic factors in pediatric Hodgkin lymphoma: experience from a developing country. Leuk Lymphoma. 2020;61(2):344-350.
27. Dongre AS, Arora B, Banavali SD, et al. Analysis of prognostic factors in childhood advanced stage Hodgkin lymphoma: A retrospective study. J Clin Oncol. 2014;32(15_suppl):e21000-e21000.
28. Büyükkapu-Bay S, Çorapçıoğlu F, Aksu G, et al. Prognostic factors and treatment results of pediatric Hodgkin’s lymphoma: A single-center experience. Turk J Pediatr. 2015;57(4):359-366.
29. Arya LS, Dinand V, Bakhshi S, et al. Significance of splenomegaly in childhood Hodgkin disease. J Pediatr Hematol Oncol. 2004;26(12):807-812.
30. Belgaumi A, Al-Kofide AA, Khafaga Y, et al. Clinical characteristics and outcome of pediatric patients with stage IV Hodgkin lymphoma. Hematol Oncol Stem Cell Ther. 2009;2(1):278-284.
2. Ketchen D. Epidemiology and Treatment Outcome of Lymphomas in Children: A Study From a Developing Area in Cameroon. J Glob Oncol. 2018;4(Supplement 2).
3. Kebudi R, Buyukkapu SB, Gorgun O , et al. Risk adapted treatment in childhood Hodgkin’s lymphoma: Outcome and changing epidemiologic features in 25 years. Blood. 2016;128(22):4158.
4. Radhakrishnan V, Dhanushkodi M, Ganesan TS, et al. Pediatric Hodgkin lymphoma treated at Cancer Institute, Chennai, India: Long-term outcome. J Glob Oncol. 2017;3(5): 545–554.
5. Riaz S, Khan S, Badar F. Pediatric Hodgkin’s Lymphoma: 5-Year Experience at Single Center in Pakistan. Blood. 2014;124(21):5455.
6. Buch N, Mehta P, Bafna V, et al. Abandonment of therapy and consequent loss to follow up is related to disease prognosis. Experience of a tertiary care center in a developing country. Pediatr Blood Cancer. 2009;53(5):701-915.
7. Stanley CC, van der Gronde T, Westmoreland KD, et al. Risk factors and reasons for treatment abandonment among children with lymphoma in Malawi. Support Care Cancer. 2018;26(3):967-973.
8. Diagne, F. B., Moreira, C., Diouf, N., Edan, C., Raquin, M. A., & Patte, C. (2015, November). Pediatric Hodgkin lymphoma treatment with chemotherapy alone: FRENCH-AFRICAN pediatric oncology group (GFAOP) experience. In pediatric blood & cancer (Vol. 62, pp. S147-S147). 111 river st, hoboken 07030-5774, NJ USA: Wiley-Blackwell.
9. Ngoc Lan B, Castor A, Wiebe T, et al. Adherence to childhood cancer treatment: A prospective cohort study from Northern Vietnam. BMJ Open. 2019;9(8): e026863.
10. Jadhav A, Dhingra H, Kalra M, et al. Treatment refusal and abandonment in childhood cancer at a tertiary care center in North India. Pediatr Hematol Oncol J. 2017;2(2):S10.
11. Kelly KM, Cole PD, Pei Q, et al. Response-adapted therapy for the treatment of children with newly diagnosed high-risk Hodgkin lymphoma (AHOD0831): a report from the Children’s Oncology Group. Br J Haematol. 2019;187(1):39-48.
12. Jhawar SR, Rivera-Núñez Z, Drachtman R, et al. Association of Combined Modality Therapy vs Chemotherapy Alone with Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma. JAMA Oncol. 2019;5(5):689-695.
13. Hudson MM, Krasin M, Link MP, et al. Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin’s disease. J Clin Oncol. 2004;22(22): 4541-50.
14. Schellong G, Pötter R, Brämswig J, et al. High cure rates and reduced long-term toxicity in pediatric Hodgkin’s disease: The German-Austrian multicenter trial DAL-HD-90. J Clin Oncol. 1999;17(12):3736-44.
15. Weiner M, Leventhalt B, Brecher M, et al. Randomized study of intensive MOPP-ABVD with or without low-dose total-nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB and IV Hodgkin’s disease in pediatric patients: a pediatric oncology group study. J Clin Oncol. 1997;15(8):2769-79.
16. McCarten KM, Nadel H R, Shulkin BL, et al. Imaging for diagnosis, staging and response assessment of Hodgkin lymphoma and non-Hodgkin lymphoma. Pediatr Radiol. 2019; 49(11):1545-1564.
17. Fernández KS, Schwartz CL, Chen L, et al. Outcome of adolescents and young adults compared to children with Hodgkin lymphoma treated with response-based chemotherapy on pediatric protocols: A Children’s Oncology Group report. Pediatr Blood Cancer. 2017;64(12):10.1002/pbc.26681.
18. Khedr R, Hamouda A, Naguib S, et al. Prognostic Value of Interim Positron Emission Tomography Among Children with Advanced Hodgkin Lymphoma in Developing Countries: Children Cancer Hospital Egypt Experience. Blood. 2016;128(22):4156.
19. Veron DA, Streitenberger P, Riccheri C, et al. Risk-Adapted Therapy with ABVD for Low- and Intermediate-Risk Patients and Oepa-Copdac for High Risk Patients Plus Involved-Field Radiation Therapy (IFRT) Based on Prognosis at Diagnosis and Early Response: Results from Pediatric Argentinian Collaborative Group Gatla Study for Children and Adolescents with Hodgkin Lymphoma. Blood. 2020;136(Supplement 1):13.
20. Fadoo Z, Belgaumi A, Alam M, et al. Pediatric lymphoma: A 10-year experience at a tertiary care hospital in Pakistan. J Pediatr Hematol Oncol. 2010;32(1):e14-8.
21. Hamadeh RR, Armenian HK, Zurayk HC. A study of clustering of cases of leukemia, Hodgkin’s disease and other lymphoma’s in Bahrain. Trop Geogr Med. 1981;33(1):42-48.
22. Ritter AJ, Goldstein JS, Ayers AA, et al. Rural and urban patients with diffuse large B-cell and follicular lymphoma experience reduced overall survival: a National Cancer DataBase study. Leuk Lymphoma. 2019;60(7):1656-1667.
23. Blansky D, Mantzaris I, Rohan T, et al. Influence of Rurality, Race, and Ethnicity on Non-Hodgkin Lymphoma Incidence. Clin Lymphoma, Myeloma Leuk. 2020;20(10):668-676.e5.
24. Sherief LM , Elsafy UR, Abdelkhalek ER, et al. Hodgkin lymphoma in childhood: clinicopathological features and therapy outcome at 2 centers from a developing country. Medicine (Baltimore). 2015;94(15):e670.
25. Memon W, Samad A, Sheikh GM. Hodgkin's lymphoma in cervical lymphadenopathy. Pakistan J Med Sci. 2008;24(1):118-121.
26. Ghafoor T. Prognostic factors in pediatric Hodgkin lymphoma: experience from a developing country. Leuk Lymphoma. 2020;61(2):344-350.
27. Dongre AS, Arora B, Banavali SD, et al. Analysis of prognostic factors in childhood advanced stage Hodgkin lymphoma: A retrospective study. J Clin Oncol. 2014;32(15_suppl):e21000-e21000.
28. Büyükkapu-Bay S, Çorapçıoğlu F, Aksu G, et al. Prognostic factors and treatment results of pediatric Hodgkin’s lymphoma: A single-center experience. Turk J Pediatr. 2015;57(4):359-366.
29. Arya LS, Dinand V, Bakhshi S, et al. Significance of splenomegaly in childhood Hodgkin disease. J Pediatr Hematol Oncol. 2004;26(12):807-812.
30. Belgaumi A, Al-Kofide AA, Khafaga Y, et al. Clinical characteristics and outcome of pediatric patients with stage IV Hodgkin lymphoma. Hematol Oncol Stem Cell Ther. 2009;2(1):278-284.
| Files | ||
| Issue | Vol 18 No 3 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijhoscr.v18i3.16110 | |
| Keywords | ||
| Pediatric Hodgkin lymphoma Developing nations Combination therapy | ||
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How to Cite
1.
Al-Jumaily U, Rjeib H, Al-Mosawy S, Faraj S, Metzger M. Response-Based Approach for Pediatric Hodgkin Lymphoma in Nations with Restricted Resources. Int J Hematol Oncol Stem Cell Res. 2024;18(3):285-296.
