Response-Based Approach for Pediatric Hodgkin Lymphoma in Nations with Restricted Resources

Usama  Al-Jumaily; Hamid D.  Habeeb Rjeib; Sabah  Al-Mosawy; Safa  Faraj; Monika Metzger

doi:10.18502/ijhoscr.v18i3.16110

Usama Al-Jumaily Department of Pediatrics, College of Medicine, University of Kerbala, Kerbala, Iraq
Hamid D. Habeeb Rjeib Department of Pathology, College of Medicine, University of Al-Qadisiyah, Al-Qadisiyah, Iraq
Sabah Al-Mosawy Department of Pediatrics, Children Teaching Hospital, Kerbala, Iraq
Safa Faraj Department of Pediatrics, College of Medicine, Wasit University, Wasit, Iraq
Monika Metzger Department of Pediatrics, St. Jude Children`s Research Hospital, Memphis, USA

DOI: https://doi.org/10.18502/ijhoscr.v18i3.16110

Keywords: Pediatric Hodgkin lymphoma; Developing nations, Combination therapy

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.