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Testi AM, Al-Jadiry MF, Moleti ML, Uccini S, Al-Darraij AF, Al-Saeed RM, Ghali HH, Sabhan AH, Fadhil SA, Al-Badri SA, Alsaadawi AR, Hameedi AD, Shanshal MH, Al-Agele YS, Al-Saffar FAR, Yaseen NK, Piciocchi A, Marsili G, Al-Hadad SA. Hodgkin Lymphoma in Children: A 16-year Experience at the Children's Welfare Teaching Hospital of Baghdad, Iraq. Mediterr J Hematol Infect Dis 2024; 16:e2024053. [PMID: 38984093 PMCID: PMC11232685 DOI: 10.4084/mjhid.2024.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/16/2024] [Indexed: 07/11/2024] Open
Abstract
Background Childhood Hodgkin lymphoma (HL) is an eminently curable disease. Good outcomes can be achieved even in resource-limited settings, and the focus is increasingly on limiting long-term toxicity. Contemporary treatment incorporates a risk-stratified, response-adapted approach using multiagent chemotherapy with/without low-dose radiotherapy. Many developing countries continue to use ABVD-based regimens due to limited acute toxicity, cost, and ease of delivery. Objective We herein report the outcomes of childhood HL diagnosed and treated in an Iraqi single centre over 16 years. Methods Children ≤14 years old with biopsy-proven HL were enrolled. Most patients received ABVD chemotherapy or COPP/ABV when Dacarbazine was unavailable. Radiotherapy was not available. Results Three hundred-three children were consecutively newly diagnosed with HL; 284 were considered eligible for the retrospective analysis (treatment refusals 9; deaths before therapy 5; initially diagnosed of non-Hodgkin lymphoma 5). ABVD scheme was administered to 184 children (65%), COPP/ABV to 83 (29%), and other schemes to the remaining 17 patients. Complete response (CR) was achieved in 277 (98%); 4 (1.4%) showed disease progression, and 1 had stable disease. Four patients in CR abandoned therapy and were in CR at the time of analysis, 2 died from infection. Relapse occurred in 42 patients (15%). The 15-year OS and EFS are 89.7% and 70.3%, respectively. Conclusion In this single Centre, over 16 years, almost 90% of children suffering from HL survive, despite the numerous limitations in diagnostic procedures, shortage of chemotherapy, no radiotherapy facilities, absence of effective second-line treatments, and finally, therapy abandonment for social and financial reasons.
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Affiliation(s)
- Anna Maria Testi
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Mazin Faisal Al-Jadiry
- College of Medicine-University of Baghdad, Children Welfare Teaching Hospital-Medical City, Pediatrics, Baghdad, Iraq
| | - Maria Luisa Moleti
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Stefania Uccini
- Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Hasanein Habeeb Ghali
- College of Medicine-University of Baghdad, Children Welfare Teaching Hospital-Medical City, Pediatrics, Baghdad, Iraq
| | - Ahmed Hatem Sabhan
- Children Welfare Teaching Hospital-Medical City, Oncology Unit, Baghdad, Iraq
| | | | - Safaa Abdulelah Al-Badri
- College of Medicine-Wasit University, Children’s Welfare Teaching Hospital-PaediatricOncology Unit, Medical City, Pediatrics, Baghdad, Iraq
| | | | - Ameer Dh Hameedi
- College of Medicine, University of Baghdad, Pathology, Baghdad, Iraq
| | | | | | | | - Nihal Khalid Yaseen
- Children Welfare Teaching Hospital-Medical City, Oncology Unit, Baghdad, Iraq
| | | | | | - Salma Abbas Al-Hadad
- College of Medicine-University of Baghdad, Children Welfare Teaching Hospital-Medical City, Pediatrics, Baghdad, Iraq
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Kourti M, Papakonstantinou E, Papagianni A, Arsos G, Ioannidou M, Pantoleon A, Antari V, Palabougiouki M, Kouskouras K, Venizelos I, Κoletsa T, Cheva A, Anastasiou A, Totikidis G, Tragiannidis A, Galli-Tsinopoulou A, Hatzipantelis E. Hodgkin Lymphoma in Children and Adolescents of Northern Greece: 25-Year Results and Long-term Follow-up. J Pediatr Hematol Oncol 2023; 45:322-326. [PMID: 36716084 DOI: 10.1097/mph.0000000000002625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/03/2022] [Indexed: 01/31/2023]
Abstract
Aim of this study was to evaluate the long-term therapeutic outcome and treatment-related complications in Hodgkin disease. We reviewed the medical records of 93 patients diagnosed with classic Hodgkin lymphoma, treated, and followed-up during the last 25 years. The cohort study included 49 males and 44 females with median age 11.8 years old (range: 3.95 to 17.42 y). The most common subtype was nodular sclerosis in 47/93 (50.5%). B symptoms were present in 15/93 (16.1%). From January 2009 until December 2020, 55 (59%) patients diagnosed with Hodgkin lymphoma were treated according to European Network for Pediatric Hodgkin Lymphoma (EURONET)-PHL-C1 protocol. Concerning outcome, a total of 89/93 patients are alive. Relapse occurred in 7/93. Second malignancies are reported in a total of 5 patients, 3 solid tumors (thyroid cancer, breast cancer, and osteosarcoma), and 2 acute myeloid leukemias. The overall survival and event-free survival for the whole cohort were 95.7% and 83.9%, respectively. Disease-free survival was 92.5%. Although a considerable high fraction of patients with Hodgkin disease can achieve continuous complete remission, they are at a high risk of developing long-term treatment-related complications. High curative rates as well as prevention of late effects can be achieved by implementation of individualized treatment strategies and innovative treatments.
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Affiliation(s)
| | | | - Andromachi Papagianni
- Children & Adolescent Hematology-Oncology Unit, Second Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki
| | - George Arsos
- Third Department of Nuclear Medicine, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki
| | - Maria Ioannidou
- Children & Adolescent Hematology-Oncology Unit, Second Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki
| | | | | | - Maria Palabougiouki
- Children & Adolescent Hematology-Oncology Unit, Second Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki
| | | | | | - Triantafyllia Κoletsa
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, University Campus, Greece
| | - Angeliki Cheva
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, University Campus, Greece
| | | | | | - Athanasios Tragiannidis
- Children & Adolescent Hematology-Oncology Unit, Second Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki
| | - Assimina Galli-Tsinopoulou
- Children & Adolescent Hematology-Oncology Unit, Second Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki
| | - Emmanuel Hatzipantelis
- Children & Adolescent Hematology-Oncology Unit, Second Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki
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Geel J, Hendricks M, Goga Y, Neethling B, Netshituni V, Mathew R, Vermeulen J, van Zyl A, Omar F, du Plessis J, du Plessis L, Madzhia E, Ngcana T, Naidoo T, Louw L, Ballot DE, Metzger ML. SACCSG HL-2018. Barriers and enablers of a harmonized treatment protocol for childhood and adolescent Hodgkin lymphoma in South Africa. Pediatr Hematol Oncol 2023; 40:300-313. [PMID: 36661569 DOI: 10.1080/08880018.2022.2162651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction: Collaborative studies have contributed to improved survival of pediatric Hodgkin lymphoma in well-resourced settings, but few are documented in resource-constrained countries. The South Africa Children's Cancer Study Group initiated harmonization of management protocols in 2015. This article analyzes barriers and enablers of the process. Methods: Clinician-researchers at 11 state-funded pediatric oncology units completed preparatory questionnaires in June 2018. Parameters included infrastructure, access to therapeutic modalities and clinician numbers. A reassessment of 13 sites (two new pediatric oncology unit) in February 2021 ascertained changes in resources and identified challenges to full participation. Questions investigated the presence and quality of diagnostic radiology, availability of surgeons, cytology/pathology options and hematology laboratory facilities. Results: The response rate was 11/11 to survey 1 and 13/13 to survey 2. The anticipated pre-study barriers to participation of pediatric oncology units included time constraints and understaffing. PET-CT was unavailable to two centers. The majority of pediatric oncology units met the minimum criteria to participate. The interim survey confirmed chemotherapy and radiotherapy availability nearly 100% of the time. One site reported improved access to radiotherapy while another reported improved access to PET-CT. Barriers to participation included excessive times to obtain regulatory approvals, time constraints and lack of dedicated research staff. Enablers include the simple management algorithm and communication tools. Conclusion: This study demonstrates that multicenter collaboration and harmonization of management protocols are achievable in a middle-income setting. Minimal funding is required but full participation to run high-quality studies requires more financial investment. Focused funding and increased prioritization of research may address systemic barriers to full participation.
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Affiliation(s)
- Jennifer Geel
- Pediatric Haematology-Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Marc Hendricks
- Pediatric Haematology-Oncology, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Yasmin Goga
- Pediatric Haematology-Oncology, University of KwaZulu-Natal, Inkosi Albert Luthuli Hospital, Durban, South Africa
| | - Beverley Neethling
- Pediatric Haematology-Oncology, University of KwaZulu-Natal, Durban, Inkosi Albert Luthuli Hospital and Greys Hospital, Pietermaritzburg, South Africa
| | - Vutshilo Netshituni
- Pediatric Haematology-Oncology, University of Limpopo, Polokwane-Mankweng Hospital Complex, Polokwane, South Africa
| | - Rema Mathew
- Pediatric Haematology-Oncology, Walter Sisulu University, Frere Hospital, East London, South Africa
| | - Johani Vermeulen
- Pediatric Haematology-Oncology, Walter Sisulu University, Dora Nginza Hospital, Qheberha, South Africa
| | - Anel van Zyl
- Pediatric Haematology-Oncology, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Fareed Omar
- Pediatric Haematology-Oncology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Jan du Plessis
- Pediatric Haematology-Oncology, University of the Free State, Universitas Hospital, Bloemfontein, South Africa
| | - Liezl du Plessis
- Pediatric Haematology-Oncology, University of the Free State, Kimberley Hospital, Kimberley, South Africa
| | - Elelwani Madzhia
- Pediatric Haematology-Oncology, Sefako Makgatho University, Dr George Mukhari Hospital, Garankuwa, South Africa
| | - Thandeka Ngcana
- Pediatric Haematology-Oncology, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Thanushree Naidoo
- Department of Radiation Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Lizette Louw
- Department of Nuclear Medicine, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Daynia E Ballot
- School of Clinical Medicine, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Palayullakandi A, Trehan A, Jain R, Kumar R, Mittal BR, Kapoor R, Srinivasan R, Kakkar N, Bansal D. Retrospective single-center experience with OEPA/COPDAC and PET-CT based strategy for pediatric Hodgkin lymphoma in a LMIC setting. Pediatr Hematol Oncol 2022; 39:587-599. [PMID: 35271413 DOI: 10.1080/08880018.2022.2044418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABVD regimen for Hodgkin lymphoma (HL) is frequently used in children and young adults in low-middle income countries (LMIC). The feasibility and safety data for 'non-ABVD' protocols from LMIC is limited. The retrospective study was conducted in a single center in India. The Euronet PHL-C1 based protocol was administered during 2010-19. A PET-CT was performed at diagnosis and following two OEPA cycles. Radiotherapy was administered for inadequate PET response. During the 10-year period, 143 patients with HL were treated. The mean age was 7.8 ± 2.5 years. Bulky disease was observed in 82 (59%). Treatment abandonment was recorded in 13 (9.1%). The median follow-up duration was 46.4 months. An inadequate PET response was observed in 41/119 (34.4%), of which 56.1% received radiotherapy. Twelve (29.3%) patients who were supposed to receive radiotherapy received 2-cycles of COPDAC instead. Sixty-nine episodes of febrile neutropenia were observed in 54 patients. Treatment-related mortality (TRM) was observed in 7 (5.3%). The majority of episodes of febrile neutropenia (61%) and TRM (86%) occurred in the first cycle of OEPA. The 4-year event-free survival (EFS) and overall survival (OS) were 86.2 ± 3.4% and 93.5 ± 2.2%, respectively. Nine (6.3%) patients relapsed. Bulky disease lacked association with inadequate PET response (p = .800) or relapse (p = 1.000). OEPA/COPDAC regimen and response assessment by PET-CT permitted therapy reduction, including radiotherapy. Febrile neutropenia and resultant TRM (5.3%) are concerning and occurred frequently in the first cycle of OEPA. The support system for managing febrile neutropenia should be optimized for administering OEPA in LMIC.
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Affiliation(s)
- Achanya Palayullakandi
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Richa Jain
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rodriguez-Hernandez A, Giulino-Roth L. The ABVD’s of cooperative trials in pediatric Hodgkin lymphoma: The India experience. Leuk Lymphoma 2022; 63:1017-1019. [DOI: 10.1080/10428194.2022.2045602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alexandra Rodriguez-Hernandez
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Weill Cornell Medical College, New York, NY, USA
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lisa Giulino-Roth
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Weill Cornell Medical College, New York, NY, USA
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6
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Yu TC, Yu SC, Wang RC, Lai SF, Teng CLJ, Lin JW, Lin WL, Huang TC. Investigating early progression of Hodgkin lymphoma in a two-center analysis. J Formos Med Assoc 2022; 121:1215-1222. [PMID: 35022156 DOI: 10.1016/j.jfma.2021.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND/PURPOSE The early progression of disease (POD) of Hodgkin lymphoma (HL) leads to a poor prognosis. To identify risk factors for early POD, this retrospective two-center cohort analysis was conducted. METHODS Medical records of HL patients between 1998 and 2020 from two referral centers were reviewed. RESULTS Two-hundred and sixty-nine patients were analyzed. The distribution of early vs. advanced stages was 51.1 vs. 48.9%, respectively. The 5-year progression free survival (PFS) was 63%, and the overall survival (OS) was 87% with a median follow-up of 52.0 months. The complete remission (CR) rate was 85.7%. Disease progression or relapsed disease occurred in 33.9% (n = 85) of patients while 17.0% of this cohort had early POD within 12 months of induction therapy. Patients with early POD had a worse median OS than those without (p < 0.001). Failure to achieve post-induction CR and high international prognostic score (IPS, 3-7) were independent risk factors for early POD. Compared with chemotherapy alone, consolidative radiotherapy after induction chemotherapy was associated with a lower risk of early POD (21.3% vs. 6.2%, p = 0.006). CONCLUSION High IPS was an independent risk factor for early POD, which was less observed in those with consolidative radiotherapy.
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Affiliation(s)
- Ta-Chuan Yu
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Shan-Chi Yu
- Department and Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ren-Ching Wang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Nursing, College of Nursing, HungKuang University, Taichung, Taiwan
| | - Shih-Fan Lai
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Lin Jerry Teng
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jing-Wei Lin
- Department of Radiation Oncology, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Wan-Ling Lin
- Department of Nuclear Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Tai-Chung Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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7
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Jain S, Bakhshi S, Seth R, Verma N, Singh M, Mahajan A, Radhakrishnan V, Mandal P, Arora R, Dinand V, Kalra M, Sharma A, Taluja A, Thulkar S, Biswas A, Chandra J. Risk based and response adapted radiation therapy for children and adolescents with newly diagnosed advanced stage Hodgkin lymphoma treated with ABVD chemotherapy: a report from the Indian pediatric oncology group study InPOG-HL-15-01. Leuk Lymphoma 2021; 63:1111-1118. [PMID: 34881686 DOI: 10.1080/10428194.2021.2012659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This multi-centric prospective study (InPOG-HL-15-01) assessed epidemiological, clinical and outcome data of advanced stage Hodgkin Lymphoma (IIB, III and IV) in children and adolescents (N = 262). Chemotherapy regimen was ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and radiotherapy (RT) was restricted to patients with bulky disease at diagnosis or with suboptimal response at early response assessment (ERA). ERA revealed complete response in 175 (68.1%), partial response in 77 (29.9%), stable disease in 2 (0.8%), and progressive disease in 3 (1.2%) patients. RT was administered to 111 (97 bulky disease, 14 suboptimal response) patients. Five-year event free (EFS) and overall survival for the whole cohort was 81.1% and 90.8% respectively. On multivariate analysis, the only statistically significant predictor of EFS was use of RT (89% versus 74.2%; p-value <0.001). This study reinforces the benefit of consolidative RT in bulky disease and in those with suboptimal response at ERA on an ABVD backbone.
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Affiliation(s)
- Sandeep Jain
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sameer Bakhshi
- Pediatric Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Seth
- Pediatric Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Verma
- Pediatrics, King George Medical University, Lucknow, India
| | - Manisha Singh
- Medical and Pediatric Oncology, Mahavir Cancer Sansthan and Research Centre, Patna, India
| | - Amita Mahajan
- Pediatric Oncology, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi, India
| | | | - Piali Mandal
- Kalawati Saran Children's Hospital, New Delhi, India
| | | | - Veronique Dinand
- Palliative and Supportive Unit, Bai Jerbai Wadia Hospital for Children, Parel, India
| | - Manas Kalra
- Pediatric Hematology Oncology and BMT, Sir Ganga Ram Hospital, New Delhi, India
| | - Anurag Sharma
- Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | - Sanjay Thulkar
- Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Radiations Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Chandra
- Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India
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8
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Mittal A, Bhethanabhotla S, Ganguly S, Vishnubhatla S, Khadgawat R, Patel C, Mohan A, Biswas A, Bakhshi S. Late effects in pediatric Hodgkin lymphoma survivors after uniform treatment with ABVD with or without radiotherapy. Pediatr Blood Cancer 2021; 68:e29293. [PMID: 34431211 DOI: 10.1002/pbc.29293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/13/2021] [Accepted: 07/31/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE ABVD (doxorubicin, bleomycin,vinblastine, and dacarbazine) is not a standard regimen in children due to concerns regarding late effects. However, no studies have evaluated long-term toxicities of ABVD in children. METHODS Total 154 pediatric Hodgkin lymphoma (HL) survivors uniformly treated with ABVD were clinically followed up as per institutional protocol. All participants were evaluated for cardiac, pulmonary, and thyroid function abnormalities by multigated acquisition scan (MUGA) scan, spirometry with diffusion capacity of lung for the uptake of carbon monoxide (DLCO), and thyroid profile test, respectively, at a single time point. Predictors of toxicity were also analyzed. RESULTS The median duration of follow-up of the cohort was 10.3 years (6.04-16.8). No secondary malignant neoplasm (SMN) or symptomatic cardiac/pulmonary toxicities were detected. Nine patients (5.9%) had left ventricular ejection fraction (LVEF) <55%. Subclinical and overt hypothyroidism were observed in 78 (50.6%) and 16 (10.4%) survivors, respectively. Abnormal spirometry and reduced DLCO was observed in 43.2% and 42.0% survivors, respectively. Receiving neck radiation was significantly associated with thyroid dysfunction (odds ratio [OR] 16.04, p < .001); age ≥10 years predicted reduced DLCO (OR 4.12, p = .001). Sixty-three and 33 patients had one and two late adverse effects, respectively; receiving neck radiation predicted development of multiple late effects (proportional OR 4.72, p < 0.001). Cumulative dose of chemotherapy did not predict toxicity. CONCLUSIONS Overall, ABVD appears safe in children at a relatively short follow-up. Long-term safety data are required before it can be adopted for treating pediatric HL patients. Children receiving neck radiation require close follow-up.
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Affiliation(s)
- Abhenil Mittal
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sainath Bhethanabhotla
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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9
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Mahajan A, Singh M, Bakhshi S, Jain S, Radhakrishnan V, Verma N, Seth R, Arora RS, Dinand V, Kalra M, Mandal P, Kapoor G, Sajid M, Thulkar S, Arora A, Taluja A, Chandra J. Treating early-stage Hodgkin lymphoma in resource-limited settings: InPOG-HL-15-01 experience. Pediatr Blood Cancer 2021; 68:e29219. [PMID: 34291860 DOI: 10.1002/pbc.29219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) in childhood is an eminently curable disease. Excellent outcomes can be achieved even in resource-limited settings and increasingly, the focus is on limiting long-term toxicity. Contemporary treatment incorporates a risk-stratified, response-adapted approach using multiagent chemotherapy with or without low-dose radiotherapy (RT). Many developing countries continue to use ABVD (adriamycin, bleomycin, vinblastin, and dacarbazine)-based regimen owing to limited acute toxicity, cost, and ease of delivery. We report outcomes of children with early-stage HL using limited cycles of ABVD-based treatment in the first prospective multicentric collaborative study from India InPOG-HL-15-01. METHODS Children <18 years with biopsy-proven HL were enrolled. Patients with stages I and IIA with or without bulky disease were classified as having early-stage disease. Patients were planned to receive four cycles of ABVD subject to satisfactory early response assessment (ERA) scheduled after two cycles of chemotherapy. RT was limited to patients with bulky disease or those with suboptimal ERA. RESULTS Four hundred ten patients were enrolled over 30 months from 27 centers. One hundred thirty-four were classified as having early-stage disease. Fifty-three (40%) of these had bulky disease. One hundred ten (83%) of this cohort achieved complete or very good partial ERA. Fifty-four (40%) received RT. At a median of 52 months since diagnosis, 5-year event-free survival (EFS) and overall survival (OS) is 94% and 95.5%, respectively. Treatment-related mortality and abandonment were <1%. CONCLUSION Limited cycles of ABVD with RT to selected patients is a very effective option for patients with early-stage disease in resource-limited settings.
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Affiliation(s)
- Amita Mahajan
- Department of Pediatric Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Manisha Singh
- Department of Medical and Pediatric Oncology, Mahavir Cancer Sansthan, Patna, India
| | - Sameer Bakhshi
- Department of Pediatric Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Jain
- Department of Pediatric Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India
| | | | - Nishant Verma
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Rachna Seth
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Veronique Dinand
- Department of Palliative and Supportive Unit, BJ Wadia Hospital, Mumbai, India
| | - Manas Kalra
- Department of Pediatric Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Piali Mandal
- Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India
| | - Gauri Kapoor
- Department of Pediatric Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India
| | - Mohammad Sajid
- Department of Medical and Pediatric Oncology, Mahavir Cancer Sansthan, Patna, India
| | - Sanjay Thulkar
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Arora
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Jagdish Chandra
- Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India
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Karpurmath SV, Rathnam K, Seshachalam A, Srinivasan A, Scott J, G. RS, Janarthinakani M, Prasad K, Patil C, Anoop P, Reddy N, Anumula SK, Roopa SP, Golamari KR, Danthala M, Malipatil B, Rangarajan B, Udupa KS, Nandennavar M, Niraimathi K. Role of Interim PET Scan after 2 Cycles of ABVD in Pediatric Hodgkin Lymphoma: Retrospective Multicenter Study from South India. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1730240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Introduction Most Indian centers use Adriamycin/Bleomycin/Vinblastine/Dacarba-zine (ABVD) chemotherapy for pediatric Hodgkin lymphoma (pHL). To reduce the late toxicity, robust predictive markers are needed to risk stratify pHL patients, thereby limiting the number of chemotherapy cycles and omitting radiation for low-risk and intensifying treatment for high-risk children.
Objective This study was conducted to analyze the outcome of pHL patients treated with ABVD and various factors predicting the outcome.
Materials and Methods This retrospective study analyzed the outcome of 113 consecutive pHL children treated with ABVD chemotherapy from 11 tertiary care centers in South India from 2009 to 2019.
Results The median duration of follow-up was 2.73 years. The median age was 13 years. B symptoms are seen in 50.5% patients, bulky disease in 23%, and stage IV in 28.3%. Of 113 pHL, 69% had a positron emission tomography (PET) and 31% had computed tomography (CT)-based staging. Stage IV (37.1%) and extranodal involvement (31.2%) were seen more often with PET than with CT staging (8.5 and 2.8%, respectively). Among 64 patients with interim PET scan after two cycles (iPET2), 20.3% did not achieve complete remission (CR) and no factors were significantly associated. The 4-year event-free survival (EFS) rate of the entire cohort was 86%. The 4-year EFS rate was 93% for patients with CR in iPET2 and 52% for patients not achieving CR. The only independent predictor of low EFS was iPET2 response (p < 0.05).
Conclusion Our study confirms the prognostic role of PET scan staging and response assessment. Not achieving CR on the iPET2 scan indicates poor prognosis and warrants clinical trial enrollment for a better outcome.
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Affiliation(s)
| | | | | | - Arathi Srinivasan
- Kanchi Kamakoti CHILDS Trust Hospital, Nungambakkam, Chennai, Tamil Nadu, India
| | - Julius Scott
- Sri Ramachandra Medical Center, Porur, Chennai, Tamil Nadu, India
| | - Raman S. G.
- Madras Cancer Care Foundation, Chennai, Tamil Nadu, India
| | | | - Krishna Prasad
- Mangalore Institute of Oncology, Mangaluru, Karnataka, India
| | | | | | | | | | | | | | | | | | | | | | - Manjunath Nandennavar
- Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
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11
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Wu B, Wang J, Zhu J, Zhen ZZ, Lu SY, Sun FF, Huang JT, Sun XF. [A single-center retrospective analysis of 85 children and adolescents with limited-stage Hodgkin lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:649-654. [PMID: 32942818 PMCID: PMC7525178 DOI: 10.3760/cma.j.issn.0253-2727.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To summarize the efficiency and long-term outcomes of limited-stage Hodgkin lymphoma in children and adolescents with ABVD therapy and determined whether omitting radiotherapy for a low-risk patient enabled the achievement of complete response (CR) after chemotherapy. Methods: We retrospectively analyzed data from 13 y (2004-2016) from patients aged ≤18 y with limited-stage HL admitted to the Sun Yat-sen University Cancer Center. Patients received treatment with ABVD chemotherapy alone or ABVD chemotherapy followed by low-dose involved field radiotherapy. Results: Total 85 subjects were eligible for study inclusion; the median age was 12 (3-18) y; 66 (77.6%) were men, 80 (94.1%) had stage-II disease, 56 (65.9%) were at low-risk, and the median follow-up duration was 72 (8-196) months; 12 relapsed, 2 had secondary neoplasm, and 2 died. The 5-year event free survival (EFS) was (85.6±3.8) %, and the overall survival (OS) was 100%. The 5-year EFS and OS was (89.1±4.2) % and 100%, respectively, for the low-risk cohort and (79.3±7.5) % and 100%, respectively for the intermediate-risk cohort. Among the 39 low-risk patients who achieved CR after chemotherapy, 15 received treatment with chemotherapy followed by LD-IFRT. In the exploratory subset analysis, the low-risk cohort who achieved CR after chemotherapy, the 5-year EFS for comparing ABVD alone with chemotherapy followed by LD-IFRT was (87.0±7.0) % versus 100% (P=0.506) , and the OS was 100% for both the groups. Conclusions: Our retrospective analysis showed excellent survival of limited-stage HL patients with ABVD therapy. For patients who achieving CR after chemotherapy with low-risk HL, received chemotherapy followed by LD-IFRT does not improve 5-year OS and EFS. The use of risk- and response-based stratification may facilitate the development of effective and less toxic protocols.
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Affiliation(s)
- B Wu
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - J Wang
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - J Zhu
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Z Z Zhen
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - S Y Lu
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - F F Sun
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - J T Huang
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - X F Sun
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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Mehrvar A, Tashvighi M, Nourian M, Mehrvar N, Ghorbani R, Sadeghi Y, Alebouyeh M, Faranoush M. Childhood Hodgkin Lymphoma in Iran; survival and outcome. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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Seshachalam A, Karpurmath SV, Rathnam K, Raman SG, Janarthinakani M, Prasad K, Patil C, Anoop P, Reddy N, Anumula SK, Roopa SP, Golamari KR, Danthala M, Gunari P, Malipatil B, Rangarajan B, Udupa KS, Nandennavar M, Niraimathi K, Shewade HD. Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence. J Glob Oncol 2020; 5:1-13. [PMID: 31834832 PMCID: PMC6939745 DOI: 10.1200/jgo.19.00179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS (P < .000). CONCLUSION Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Karuna Trust, Bengaluru, India
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Boo YL, Ting HSY, Yap DFS, Toh SG, Lim SM. Clinical features and treatment outcomes of Hodgkin lymphoma: A retrospective review in a Malaysian tertiary hospital. Blood Res 2019; 54:210-217. [PMID: 31730690 PMCID: PMC6779942 DOI: 10.5045/br.2019.54.3.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/07/2019] [Accepted: 08/08/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Classical Hodgkin lymphoma (cHL) is a clinicopathologically unique, aggressive lymphoma arising from germinal center B-cells and is one of the most curable hematological malignancies. This study aimed to determine the clinical course, treatment regimens, response rates, and survival data of patients diagnosed with cHL in a tertiary center. METHODS A retrospective review was conducted to include patients with a diagnosis of cHL from 2013 to 2017. Data of demographic and clinical characteristics, treatment regimens, and outcomes were collected and analyzed. RESULTS We recruited 94 patients with a median age of 27.0 [interquartile range (IQR), 12] years. Most of the patients were male (61.7%) and 73.4% were ethnic Malay. Nodular sclerosis was the most common histology (77.6%), followed by mixed cellularity (6.4%) and others (16%). The median follow-up time was 28.0 (IQR, 32) months. All patients received chemotherapy but only 13.8% received radiotherapy as consolidation. The doxorubicin-bleomycin-vinblastine-dacarbazine regimen was the most common (85.1%), followed by the escalated bleomycin-etoposide-doxorubicin-cyclophosphamide-vincristineprednisolone-procarbazine regimen (14.9%). Following treatment, 76.1% of patients achieved complete response. The 2-year overall survival (OS) and progression-free survival (PFS) of the entire cohort were 96.5% and 71.1%, respectively. The 2-year OS and PFS for advanced-stage disease were 93.9% and 62.8%, compared to 100% and 82.7% for early-stage disease, respectively (P=0.252 and P=0.052, respectively). CONCLUSION This study provides insight into the clinical presentation and treatment outcomes among patients with cHL in Malaysia. A longer study duration is required to identify OS and PFS benefits and treatment-related complications for different chemotherapeutic regimens.
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Affiliation(s)
- Yang Liang Boo
- Department of Haematology, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Helen Siew Yean Ting
- Department of Haematology, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Diana Fui Sing Yap
- Department of Pharmacy, Hospital Enche' Besar Hajjah Khalsom, Ministry of Health Malaysia, Kluang, Johor, Malaysia
| | - See Guan Toh
- Department of Haematology, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Soo Min Lim
- Department of Haematology, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
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Gómez-Almaguer D, González-Llano O, Jiménez-Antolinez V, Gómez-De León A. Treatment of classical Hodgkin’s lymphoma in children and adolescents. Expert Opin Pharmacother 2019; 20:1227-1234. [DOI: 10.1080/14656566.2019.1606212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David Gómez-Almaguer
- Service of Hematology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Oscar González-Llano
- Service of Hematology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Valentine Jiménez-Antolinez
- Service of Hematology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Gómez-De León
- Service of Hematology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
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Gupta V, Singh TB, Gupta SK. Response and Relapses in Pediatric Hodgkin's Lymphoma Treated with Chemotherapy Alone. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_13_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Vineeta Gupta
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tej Bali Singh
- Department of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sanjeev Kumar Gupta
- Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Frias S, Ramos S, Salas C, Molina B, Sánchez S, Rivera-Luna R. Nonclonal Chromosome Aberrations and Genome Chaos in Somatic and Germ Cells from Patients and Survivors of Hodgkin Lymphoma. Genes (Basel) 2019; 10:genes10010037. [PMID: 30634664 PMCID: PMC6357137 DOI: 10.3390/genes10010037] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2018] [Accepted: 01/04/2019] [Indexed: 12/27/2022] Open
Abstract
Anticancer regimens for Hodgkin lymphoma (HL) patients include highly genotoxic drugs that have been very successful in killing tumor cells and providing a 90% disease-free survival at five years. However, some of these treatments do not have a specific cell target, damaging both cancerous and normal cells. Thus, HL survivors have a high risk of developing new primary cancers, both hematologic and solid tumors, which have been related to treatment. Several studies have shown that after treatment, HL patients and survivors present persistent chromosomal instability, including nonclonal chromosomal aberrations. The frequency and type of chromosomal abnormalities appear to depend on the type of therapy and the cell type examined. For example, MOPP chemotherapy affects hematopoietic and germ stem cells leading to long-term genotoxic effects and azoospermia, while ABVD chemotherapy affects transiently sperm cells, with most of the patients showing recovery of spermatogenesis. Both regimens have long-term effects in somatic cells, presenting nonclonal chromosomal aberrations and genomic chaos in a fraction of noncancerous cells. This is a source of karyotypic heterogeneity that could eventually generate a more stable population acquiring clonal chromosomal aberrations and leading towards the development of a new cancer.
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Affiliation(s)
- Sara Frias
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Cd. De Mexico, P.O. Box 04530, Mexico.
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de Mexico, Cd. De Mexico, P.O. Box 04510, Mexico.
| | - Sandra Ramos
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Cd. De Mexico, P.O. Box 04530, Mexico.
| | - Consuelo Salas
- Laboratorio de Genética y Cáncer, Instituto Nacional de Pediatría, Cd. De Mexico, P.O. Box 04530, Mexico.
| | - Bertha Molina
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Cd. De Mexico, P.O. Box 04530, Mexico.
| | - Silvia Sánchez
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Cd. De Mexico, P.O. Box 04530, Mexico.
| | - Roberto Rivera-Luna
- Subdirección de Hemato-Oncología, Instituto Nacional de Pediatría, Cd. De Mexico, P.O. Box 04530, Mexico.
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Totadri S, Radhakrishnan V, Ganesan TS, Ganesan P, Kannan K, Lakshmipathy KM, Selvaluxmy G, Sagar TG. Can Radiotherapy Be Omitted in Children With Hodgkin Lymphoma Who Achieve Metabolic Remission on Interim Positron Emission Tomography? Experience of a Tertiary Care Cancer Referral Center. J Glob Oncol 2018; 4:1-7. [PMID: 30241201 PMCID: PMC6180840 DOI: 10.1200/jgo.2017.009340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Treating pediatric Hodgkin lymphoma (HL) involves a delicate balance between cure and reducing late toxicity. Fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT) identifies patients with early response to chemotherapy, for whom radiotherapy may be avoided. The role of PET-CT in upfront risk stratification and response-adapted treatment is evaluated in this study. METHODS Patients with HL, who were younger than 18 years, were included. PET-CT was performed at baseline and after two cycles of chemotherapy. Patients were stratified into three risk groups: group 1 (stage I or II with no unfavorable features); group 2 (stage I or II with bulky disease/B symptoms); and group 3 (stage III/IV). A doxorubicin, bleomycin, vinblastine, dacarbazine-based regimen was used in early disease. A cyclophosphamide, vincristine, prednisolone, procarbazine, doxorubicin, bleomycin, vinblastine-based regimen was used in advanced disease. RESULTS Forty-nine patients were included. Fifteen (31%), seven (14%), and 27 (55%) patients were included in groups 1, 2, and 3, respectively. Among 36 patients who underwent staging by PET-CT at diagnosis, seven (19%) patients were upstaged and one (3%) patient was downstaged by PET compared with CT. On the basis of negative interim PET responses, 39 (80%) patients were treated without radiotherapy. The 3-year event-free survival for the entire cohort was 91% (± 5.2%) and overall survival was 100%. CONCLUSION PET-CT is an excellent stand-alone staging modality in HL. The omission of radiotherapy can be considered in patients who achieve metabolic remission on interim PET.
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Shamoon RP, Ali MD, Shabila NP. Overview and outcome of Hodgkin's Lymphoma: Experience of a single developing country's oncology centre. PLoS One 2018; 13:e0195629. [PMID: 29649329 PMCID: PMC5896958 DOI: 10.1371/journal.pone.0195629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/26/2018] [Indexed: 11/18/2022] Open
Abstract
Hodgkin's Lymphoma (HL) reveals variable epidemiological and clinico-pathological features in different geographical locations. In this retrospective study, we aimed to assess the epidemiological and clinic-pathological features, and outcome of HL patients treated at one hemato-oncology centre in Erbil, northern Iraq. Medical records of 103 HL patients treated over more than six years were reviewed. Treatment outcome was evaluated by measuring the 5-year overall and progression-free survival rates. The median age of patients was 23 years, children up to 17 years constituted 31.1%, and male to female ratio was 1:1.05. The majority (96.1%) of patients presented with lymphadenopathy. Nodular sclerosis subtype was the mostly encountered histologic type (48.5%); about half of the patients (49.5%) had stage II disease. Relapse occurred in 20 patients; the 5-year overall survival for children was better (89%) compared to adult patients (79%). The associated risk features found to have adverse effects on the survival, however, only high LDH level and presence of B-symptoms at presentation showed significant correlation. The epidemiological and clinical characteristics of HL in our locality followed the pattern in the western world. The 5-year overall and progression-free survivals were far below the international rates, a matter which may necessitate a revision to HL treatment strategy at our centre.
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Affiliation(s)
- Rawand P. Shamoon
- Department of Pathology, College of Medicine, Hawler Medical University, Erbil, Iraq
- Department of Haematopathology, Nanakali Haemato-Oncology Teaching Centre, Erbil, Iraq
| | - Mohamad Dahir Ali
- Department of Clinical Haematology, Nanakali Hemato-Oncology Teaching Centre, Erbil, Iraq
| | - Nazar P. Shabila
- Department of Community Medicine, Hawler Medical University, Erbil, Iraq
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20
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Vyas C, Jain S, Kapoor G. Therapy Related AML/MDS Following Treatment for Childhood Cancer: Experience from a Tertiary Care Centre in North India. Indian J Hematol Blood Transfus 2018; 34:78-82. [PMID: 29398803 DOI: 10.1007/s12288-017-0840-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/15/2017] [Indexed: 01/03/2023] Open
Abstract
Therapy-related acute myeloid leukemia/myelodysplastic syndrome (t-AML/MDS) is a devastating late effect of cancer treatment. There is limited data on incidence of t-AML/MDS from India. We retrospectively studied pediatric t AML/MDS at our institute between January 1996 and December 2015. Among 1285 children, 8 patients developed t-AML with a median age of 15.5 years. Overall incidence of t-AML/MDS was 0.62% [0.99% (4/402) in solid tumours and 0.45% (4/883) in leukemia/lymphoma, P = 0.26] with 6390 patient years of follow up. Primary malignancy included sarcoma [bone (2), soft tissue (2)], B-non-Hodgkin lymphoma (2) and acute lymphoblastic leukemia (2). The median cumulative equivalent doses of cyclophosphamide, doxorubicin and etoposide were 6.8, 270 and 2.5 gm/m2 respectively. Two patients received radiotherapy [rhabdomyosarcoma (50 Gy), synovial sarcoma (45 Gy)]. The median latency period to develop t-AML/MDS was 24 months (range 16.5-62 months). Most common FAB morphology was M4/M5 (7/8) and cytogenetic abnormality was MLL rearrangement (4/8). Five patients opted for treatment, 4 achieved remission out of which 2 patients are alive and disease free. Short latency periods, absence of pre-leukemic phase and 11q23 translocations were characteristic in the patients with t-AML/MDS. In view of poor outcome with conventional therapy, novel strategies and prevention need to be considered.
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Affiliation(s)
- Chintan Vyas
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085 India
| | - Sandeep Jain
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085 India
| | - Gauri Kapoor
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085 India
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Marr KC, Connors JM, Savage KJ, Goddard KJ, Deyell RJ. ABVD chemotherapy with reduced radiation therapy rates in children, adolescents and young adults with all stages of Hodgkin lymphoma. Ann Oncol 2017; 28:849-854. [PMID: 28327925 DOI: 10.1093/annonc/mdx005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background We adopted ABVD chemotherapy with risk-adapted radiation therapy (RT) as first-line therapy for children, adolescents and young adults with Hodgkin lymphoma (HL) in British Columbia in 2004. Patients and methods Patients ≤ 25 years diagnosed from 2004 to 2013 with all stages of HL who received ABVD as initial therapy were included. Results Among 55 children (age < 18 year) and 154 young adults (18-25 year), there were no significant differences among age groups for sex, histologic subtype, tumour bulk, B symptoms, prognostic risk groups or treatment received. The rates of complete response, partial response and progressive disease were 84%, 7% and 10% for children and 95%, 4% and 1% for young adults (P=0.01), respectively. Treatment failures in children all occurred within one year of completion, while 8/21 (38%) relapses in young adults occurred later (P=0.04). With a median follow-up of 66 months the 5-year progression-free (PFS) and overall survival (OS) were 85 ± 3% and 97 ± 1%, respectively. For limited stage disease, PFS was 90 ± 7% for children and 93 ± 3% for young adults (P=0.65); OS was 100% for both. For advanced stage patients, PFS and OS were also similar for the children and young adults (77 ± 7% versus 81 ± 4%; P=0.38 and OS 90 ± 6% versus 97 ± 2%; P=0.17). The rate of consolidative RT was low (21%) and did not differ between age groups. Conclusion ABVD is an effective treatment in children, adolescents and young adults with HL. Children were less likely to achieve complete response and demonstrated earlier relapses compared to young adults. RT may be omitted for the majority of patients while maintaining excellent 5-year OS.
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Affiliation(s)
- K C Marr
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
| | - J M Connors
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Savage
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Goddard
- British Columbia Cancer Agency, Department of Radiation Oncology, University of British Columbia, Vancouver, Canada
| | - R J Deyell
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
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Radhakrishnan V, Kapoor G, Arora B, Bansal D, Vora T, Prasad M, Chinnaswamy G, Laskar S, Agarwala S, Kaur T, Rath GK, Bakhshi S. Management of Hodgkins Lymphoma: ICMR Consensus Document. Indian J Pediatr 2017; 84:371-381. [PMID: 28357582 DOI: 10.1007/s12098-017-2304-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/30/2017] [Indexed: 11/28/2022]
Abstract
Pediatric Hodgkins lymphoma is a highly curable disease even in the developing world. Current treatment paradigms follow a risk and response based approach. The goal is to minimise treatment related short and long-term toxicity while maintaining excellent survival. A confirmed histopathological diagnosis and full staging work-up are essential prior to embarking on treatment and guidelines for these are provided in the text. All patients require combination chemotherapy while radiotherapy is usually reserved for a select subgroup depending on the protocol used. It is important to follow these patients for relapse in the first five years and life-long for late effects as most of them will be cured.
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Affiliation(s)
- Venkatraman Radhakrishnan
- Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India
| | - Gauri Kapoor
- Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute & Research Center, Rohini, Sector 5, Delhi, 110085, India.
| | - Brijesh Arora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Deepak Bansal
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tanvir Kaur
- NCD Division, Indian Council of Medical Research (ICMR), New Delhi, India
| | - G K Rath
- Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Radhakrishnan V, Dhanushkodi M, Ganesan TS, Ganesan P, Sundersingh S, Selvaluxmy G, Swaminathan R, Rama R, Sagar TG. Pediatric Hodgkin Lymphoma Treated at Cancer Institute, Chennai, India: Long-Term Outcome. J Glob Oncol 2016; 3:545-554. [PMID: 29094094 PMCID: PMC5646877 DOI: 10.1200/jgo.2016.005314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Pediatric Hodgkin lymphoma (HL) is a highly curable malignancy. Outcomes for pediatric HL may vary between developed and developing countries for multiple reasons. This study was conducted to ascertain the outcomes of children with HL at our center and to identify risk factors for recurrent disease. Methods We analyzed the outcomes of 172 consecutive, previously untreated patients with pediatric HL presenting at our center from 2001 to 2010. Patients were treated with either adriamycin, bleomycin, vinblastine, and dacarbazine or adriamycin, bleomycin, vinblastine, cyclophosphamide, vincristine, prednisone, and procarbazine chemotherapy initially, and radiation to bulky sites or a single site of residual disease when appropriate. Results The median duration of follow-up was 77 months. The median age of the patients was 10 years; 127 (74%) of the 172 patients were male. The extent of disease was stage I and II in 59% of the patients. B symptoms were present in 32% of the patients, and 27% had bulky disease. The most common histologic subtype was mixed cellularity (45%). The 5-year overall survival (OS) and progression-free survival (PFS) of the entire cohort were 92.9% and 83.1%, respectively. The 5-year OS rates for patients with stage I, II, III, and IV were 96%, 94.7%, 84%, and 69.8%, respectively. On univariate analysis, advanced stage, response on interim radiologic assessment, and presence of B symptoms significantly predicted inferior PFS and OS. On multivariate analysis, only interim radiologic response significantly predicted PFS (P < .001) and OS (P < .001). Conclusion Overall, the outcomes of patients treated at our center are comparable to those observed in other centers in India and globally.
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