Impact of using combined chemotherapy regimen in children with Hodgkin lymphoma in countries with limited resources: a single center experience in Iraq
Main Article Content
Keywords
Hodgkin lymphoma, developing countries, combined chemotherapy
Abstract
Objective/Background: Data about Hodgkin lymphoma (HL) in developing countries are scattered. The aim of this study is to present clinical features and outcome of children with HL using combined different chemotherapy regimens. Response-based approach was applied irrespective of risk stratification.
Methods: Patients aged 18 years and younger who were diagnosed with HL between January 2014 and December 2021 in a cancer center in Iraq, were recruited. Patients were stratified into three risk groups. Initial treatment with induction chemotherapy (i.e., 2 cycles of ABVD) was applied to all patients. Patients who achieved complete radiological response to induction chemotherapy continued with 4-6 cycles of ABVD; radiotherapy was omitted. Patients with slow early response received 3 cycles of COPDac after 3rd cycle of ABVD, followed by radiotherapy.
Results: fifty-nine patients were enrolled in this study. The median age was 7 years. Twenty (33.9%) patients were stage III, followed by stage II (32.2%). Twenty-five patients had B symptoms. Initial splenic involvement was found in 11 patients. Approximately one third of patients had bulky disease (n = 19; 32.2%). The most common histology was mixed cellularity (n = 44). The median follow-up was 2.7 year (range from 0.1 to 7.5 years). The 5-year estimates of survival and EFS were 92% and 78% ±10%, respectively. Only bulky disease had a significant negative influence on the outcome.
Conclusion: Good outcomes for pediatric HL patients can be achieved in low and middle income countries. Response-based therapy approach is feasible to reduce long term treatment-related sequel.
References
hematology and oncology study,” Pediatr. Blood Cancer, vol. 60, no. 9, pp. 1464–1469, 2013, doi: 10.1002/pbc.24534.
2. D. Ketchen, “Epidemiology and Treatment Outcome of Lymphomas in Children: A Study From a Developing Area in Cameroon,” J. Glob.
Oncol., vol. 4, no. Supplement 2, 2018, doi: 10.1200/jgo.18.20400.
3. K. R. et al., “Risk adapted treatment in childhood hodgkin’s lymphoma: Outcome and changing epidemiologic features in 25 years,” Blood, vol. 128, no. 22, 2016.
4. V. Radhakrishnan et al., “Pediatric Hodgkin lymphoma treated at Cancer Institute, Chennai, India: Long-term outcome,” J. Glob. Oncol., vol.
3, no. 5, 2017, doi: 10.1200/JGO.2016.005314.
5. S. Riaz, S. Khan, and F. Badar, “Pediatric Hodgkin’s Lymphoma: 5-Year Experience at Single Center in Pakistan,” Blood, vol. 124, no.
21, 2014, doi: 10.1182/blood.v124.21.5455.5455.
6. B. N. et al., “Abandonment of therapy and consequent loss to follow up is related to disease prognosis. Experience of a tertiary care centre in a developing country,” Pediatr. Blood Cancer, vol. 53, no. 5, 2009.
7. C. C. Stanley et al., “Risk factors and reasons for treatment abandonment among children with lymphoma in Malawi,” Support. Care Cancer,
vol. 26, no. 3, pp. 967–973, Mar. 2018, doi: 10.1007/s00520-017-3917-z.
8. F. B. Diagne, C. Moreira, N. Diouf, C. Edan, M. A. Raquin, and C. Patte, “Pediatric hodgkin lymphoma treatment with chemotherapy alone:
FRENCH-AFRICAN pediatric oncology group (GFAOP) experience,” Pediatr. Blood Cancer, vol. 62, 2015.
9. L. B.N., C. A., W. T., T. J., M. C., and H. L., “Adherence to childhood cancer treatment: A prospective cohort study from Northern
Vietnam,” BMJ Open, vol. 9, no. 8, 2019.
10. A. Jadhav, H. Dhingra, M. Kalra, and A. Mahajan, “Treatment refusal and abandonment in childhood cancer at a tertiary care center in North India,” Pediatr. Hematol. Oncol. J., vol. 2, no. 2, 2017, doi: 10.1016/j.phoj.2017.11.032
11. K. M. Kelly 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., vol. 187, no. 1, 2019, doi:10.1111/bjh.16014.
12. S. R. Jhawar, Z. Rivera-Núñez, R. Drachtman, P. D. Cole, B. S. Hoppe, and R. R. Parikh, “Association of Combined Modality Therapy vs
Chemotherapy Alone with Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma,” JAMA Oncol., vol. 5, no. 5, 2019, doi:
10.1001/jamaoncol.2018.5911.
13. M. M. Hudson et al., “Risk-adapted, combinedmodality therapy with VAMP/COP and responsebased, involved-field radiation for unfavorable pediatric Hodgkin’s disease,” J. Clin. Oncol., vol. 22, no. 22, 2004, doi: 10.1200/JCO.2004.02.139.
14. G. Schellong 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., vol. 17, no. 12, 1999, doi:10.1200/JCO.1999.17.12.3736.
15. M. Weiner et al., “Randomized study of intensive MOPP-ABVD with or without low-dose totalnodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB and IV Hodgkin’s disease in pediatric patients: a pediatric oncology group study,” Cancer/Radiothérapie, vol. 2, no. 1, 1998, doi: 10.1016/s1278-3218(98)89073-2.
16. D. J. Bell and J. Cheng, “Ann Arbor staging system | Radiology Reference Article | Radiopaedia.org,” 12/12/2019, 2019. .
17. K. S. Fernández, C. L. Schwartz, L. Chen, L. S.Constine, A. Chauvenet, and P. A. de Alarcón, “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, vol. 64, no. 12, 2017, doi: 10.1002/pbc.26681.
18. R. Khedr et al., “Prognostic Value of Interim Positron Emission Tomography Among Children with Advanced Hodgkin Lymphoma in
Developing Countries: Children Cancer Hospital Egypt Experience,” Blood, vol. 128, no. 22, 2016, doi: 10.1182/blood.v128.22.4156.4156.
19. D. A. Veron 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, vol. 136, no. Supplement 1, 2020, doi: 10.1182/blood-2020-
135945.
20. Z. Fadoo, A. Belgaumi, M. Alam, I. Azam, and A. Naqvi, “Pediatric lymphoma: A 10-year experience at a tertiary care hospital in Pakistan,”
J. Pediatr. Hematol. Oncol., vol. 32, no. 1, 2010, doi: 10.1097/MPH.0b013e3181bdf1f3.
21. R. R. Hamadeh, H. K. Armenian, and H. C. Zurayk, “A study of clustering of cases of leukemia, Hodgkin’s disease and other
lymphoma’s in Bahrain,” Tropical and Geographical Medicine, vol. 33, no. 1. pp. 42–48,1981.
22. A. J. Ritter, J. S. Goldstein, A. A. Ayers, and C. R. Flowers, “Rural and urban patients with diffuse large B-cell and follicular lymphoma
experience reduced overall survival: a National Cancer DataBase study,” Leukemia and Lymphoma, vol. 60, no. 7. pp. 1656–1667, 2019,
doi: 10.1080/10428194.2018.1546855.
23. D. Blansky, I. Mantzaris, T. Rohan, and H. D. Hosgood, “Influence of Rurality, Race, and Ethnicity on Non-Hodgkin Lymphoma
Incidence,” Clinical Lymphoma, Myeloma and Leukemia, vol. 20, no. 10. pp. 668-676.e5, 2020, doi: 10.1016/j.clml.2020.05.010.
24. “Hodgkin lymphoma in childhood: clinicopathological features and therapy outcome at 2 centers from a developing country.,”
Medicine. p. 25881843, 2015.
25. W. Memon, A. Samad, and G. M. Sheikh, “Hodgkins lymphoma in cervical lymphadenopathy,” Pakistan Journal of Medical
Sciences, vol. 24, no. 1. pp. 118–121, 2008.
26. T. Ghafoor, “Prognostic factors in pediatric Hodgkin lymphoma: experience from a developing country,” Leuk. Lymphoma, vol. 61,
no. 2, 2020, doi: 10.1080/10428194.2019.1665666.
27. A. S. Dongre et al., “Analysis of prognostic factors in childhood advanced stage Hodgkin lymphoma: A retrospective study.,” Journal of
Clinical Oncology, vol. 32, no. 15_suppl. pp. e21000–e21000, 2014, doi:10.1200/jco.2014.32.15_suppl.e21000.
28. S. Büyükkapu-Bay, F. Çorapçıoğlu, G. Aksu, Y. Anık, H. Demir, and C. Erçin, “Prognostic factors and treatment results of pediatric Hodgkin’s
lymphoma: A single center experience,” Turk. J. Pediatr., vol. 57, no. 4, pp. 359–366, 2015.
29. L. S. Arya, V. Dinand, S. Bakhshi, V. Thavaraj, R. Singh, and R. Dawar, “Significance of splenomegaly in childhood Hodgkin disease,”
Journal of Pediatric Hematology/Oncology, vol.26, no. 12. pp. 807–812, 2004.
30. A. Belgaumi et al., “Clinical characteristics and outcome of pediatric patients with stage IV Hodgkin lymphoma,” Hematology/ Oncology
and Stem Cell Therapy, vol. 2, no. 1. pp. 278–284, 2009, doi: 10.1016/S1658-3876(09)50038-6.
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