Response and Relapses in Pediatric Hodgkin's Lymphoma Treated with Chemotherapy Alone

Abstract

Aims: The aims of this study were to analyze the sociodemographic profile, disease characteristics, event-free survival (EFS), overall survival (OS), and risk factors for relapse in patients with Hodgkin's lymphoma (HL) treated with only chemotherapy as per unit protocol. Subject and Methods: Case records of children with HL diagnosed and treated at our center between January 2005 and December 2014 were retrospectively analyzed. Results: A total of 90 patients with mean age of 8.13 ± 2.65 years (median age 8 years; range 4.5–15 years) were diagnosed and treated for HL during the study period. Male-to-female ratio was 7.2:1. Almost 12.2% and 87.8% of patients had early and advanced stage disease, respectively. B symptoms were present in 87.8% of patients. Mean duration of symptoms was 9.66 ± 6.30 months (median 8 months; range 2–36 months). Mixed cellularity was the most common histologic type. Multiagent chemotherapy was mainstay of treatment. OS and EFS were 88.8% and 84.5%, respectively. OS in patients with or without bulky disease was 53.3% and 92.2%, respectively. Older age (≥10 years), presence of bulky disease, low hemoglobin (≤7.0 g/dl), and high leukocyte count (≥12000/mm³) at the time of diagnosis, and protocol used (cyclophosphamide, vincristine, procarbazine, and prednisone) were the risk factors for relapse. Conclusions: Our patient population had younger age, advanced disease, more B symptoms, and bulky disease. Still, we achieved good OS and EFS with chemotherapy-alone protocols. Patients with bulky disease had poor OS and EFS. If radiotherapy is included in the protocol for bulky disease, the survival rates can be improved further.

Keywords

Chemotherapy - Hodgkin's disease - lymphadenopathy - lymphoma - survival

Publikationsverlauf

Eingereicht: 13. Januar 2018

Angenommen: 27. April 2018

Artikel online veröffentlicht:
03. Juni 2021

• References

• 1 Chang ET, Zheng T, Weir EG, Borowitz M, Mann RB, Spiegelman D. et al. Childhood social environment and Hodgkin's lymphoma: New findings from a population-based case-control study. Cancer Epidemiol Biomarkers Prev 2004; 13: 1361-70
• 2 Dinand V, Arya LS. Epidemiology of childhood Hodgkins disease: Is it different in developing countries?. Indian Pediatr 2006; 43: 141-7
• 3 Thomas RK, Re D, Zander T, Wolf J, Diehl V. Epidemiology and etiology of Hodgkin's lymphoma. Ann Oncol 2002; 13 Suppl 4 147-52
• 4 Barros MH, Hassan R, Niedobitek G. Disease patterns in pediatric classical Hodgkin lymphoma: A report from a developing area in Brazil. Hematol Oncol 2011; 29: 190-5
• 5 Jain S, Kapoor G, Bajpai R. ABVD-based therapy for Hodgkin lymphoma in children and adolescents: Lessons learnt in a tertiary care oncology center in a developing country. Pediatr Blood Cancer 2016; 63: 1024-30
• 6 Trehan A, Singla S, Marwaha RK, Bansal D, Srinivasan R. Hodgkin lymphoma in children: Experience in a tertiary care centre in India. J Pediatr Hematol Oncol 2013; 35: 174-9
• 7 Nachman JB, Sposto R, Herzog P, Gilchrist GS, Wolden SL, Thomson J. et al. Randomized comparison of low-dose involved-field radiotherapy and no radiotherapy for children with Hodgkin's disease who achieve a complete response to chemotherapy. J Clin Oncol 2002; 20: 3765-71
• 8 Castellanos EM, Barrantes JC, Báez LF, Gamboa Y, Peña A, Alabi S. et al. Achemotherapy only therapeutic approach to pediatric Hodgkin lymphoma: AHOPCA LH 1999. Pediatr Blood Cancer 2014; 61: 997-1002
• 9 Chandra J, Naithani R, Singh V, Saxena YK, Sharma M, Pemde H. et al. Developing anticancer chemotherapy services in a developing country: Hodgkin lymphoma experience. Pediatr Blood Cancer 2008; 51: 485-8
• 10 Metzger M, Krosin MJ, Hudson MM, Pizzo PA, Poplack DG. Hodgkin Lymphoma. Priciples and Practice of Pediatric Oncology. 16th ed. Philadelphia: Wolters Kluwer/Lippincott, Williams and Wilkins; 2011: 639-62
• 11 Arya LS, Dinand V, Thavaraj V, Bakhshi S, Dawar R, Rath GK. et al. Hodgkin's disease in Indian children: Outcome with chemotherapy alone. Pediatr Blood Cancer 2006; 46: 26-34
• 12 Verma N, Kumar A. Treating Hodgkin's lymphoma in a resource poor setting: Challenges and outcome. Cancer Oncol Res 2015; 3: 11-6
• 13 Sherief LM, Elsafy UR, Abdelkhalek ER, Kamal NM, Elbehedy R, Hassan TH. et al. Hodgkin lymphoma in childhood: Clinicopathological features and therapy outcome at 2 centers from a developing country. Medicine (Baltimore) 2015; 94: e670
• 14 Arya LS, Dinand V, Bakhshi S, Thavaraj V, Singh R, Dawar R. et al. Significance of splenomegaly in childhood Hodgkin disease. J Pediatr Hematol Oncol 2004; 26: 807-12
• 15 Gupta V, Srivastava A, Bhatia B. Hodgkin disease with spinal cord compression. J Pediatr Hematol Oncol 2009; 31: 771-3
• 16 Singh P, Bakhshi S. Osseous involvement in pediatric Hodgkin's lymphoma. Indian J Pediatr 2010; 77: 565-6
• 17 Gupta V, Kumar M, Gupta SK. Ptosis: A rare presentation of Hodgkin lymphoma. J Pediatr Hematol Oncol 2014; 36: 163-5
• 18 Seth R, Das RR, Puri K, Singh P. Clinical profile and chemotherapy response in children with Hodgkin lymphoma at a tertiary care centre. J Clin Diagn Res 2015; 9: SC25-30
• 19 Ganesan P, Kumar L, Raina V, Sharma A, Bakhshi S, Sreenivas V. et al. Hodgkin's lymphoma – Long-term outcome: An experience from a tertiary care cancer center in North India. Ann Hematol 2011; 90: 1153-60
• 20 Smith RS, Chen Q, Hudson MM, Link MP, Kun L, Weinstein H. et al. Prognostic factors for children with Hodgkin's disease treated with combined-modality therapy. J Clin Oncol 2003; 21: 2026-33
• 21 Weiner MA, Leventhal B, Brecher ML, Marcus RB, Cantor A, Gieser PW. 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: 2769-79