1
|
Geel J, van Zyl A, Plessis JD, Hendricks M, Goga Y, Carr A, Neethling B, Hramyka A, Omar F, Mathew R, Louw L, Naidoo T, Ngcana T, Schickerling T, Netshituni V, Madzhia E, du Plessis L, Kelsey T, Ballot DE, Metzger ML. Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa. Pediatr Blood Cancer 2024; 71:e30712. [PMID: 37814417 DOI: 10.1002/pbc.30712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Historic South African 5-year overall survival (OS) rates for Hodgkin lymphoma (HL) from 2000 to 2010 were 46% and 84% for human immunodeficiency virus (HIV)-positive and HIV-negative children, respectively. We investigated whether a harmonised treatment protocol using risk stratification and response-adapted therapy could increase the OS of childhood and adolescent HL. METHODS Seventeen units prospectively enrolled patients less than 18 years, newly diagnosed with classical HL onto a risk-stratified, response-adapted treatment protocol from July 2016 to December 2022. Low- and intermediate-risk patients received four and six courses of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), respectively. High-risk patients received two courses of ABVD, followed by four courses of cyclophosphamide, vincristine, prednisone, and dacarbazine (COPDac). Those with a slow early response and bulky disease received consolidation radiotherapy. HIV-positive patients could receive granulocyte colony-stimulating factor and less intensive therapy if stratified as high risk, at the treating clinician's discretion. Kaplan-Meier survival analysis was performed to determine 2-year OS and Cox regression to elucidate prognostic factors. RESULTS The cohort comprised 132 patients (19 HIV-positive, 113 HIV-negative), median age of 9.7 years, with a median follow-up of 2.2 years. Risk grouping comprised nine (7%) low risk, 36 (27%) intermediate risk and 87 (66%) high risk, with 71 (54%) rapid early responders and 45 (34%) slow early responders, and 16 (12%) undocumented. Two-year OS was 100% for low-risk, 93% for intermediate-risk, and 91% for high-risk patients. OS for HIV-negative (93%) and HIV-positive (89%) patients were similar (p = .53). Absolute lymphocyte count greater than 0.6 × 109 predicted survival (94% vs. 83%, p = .02). CONCLUSION In the first South African harmonised HL treatment protocol, risk stratification correlated with prognosis. Two-year OS of HIV-positive and HIV-negative patients improved since 2010, partially ascribed to standardised treatment and increased supportive care. This improved survival strengthens the harmonisation movement and gives hope that South Africa will achieve the WHO Global Initiative for Childhood Cancer goals.
Collapse
Affiliation(s)
- Jennifer Geel
- Pediatric Haematology-Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Anel van Zyl
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jan du Plessis
- Pediatric Haematology-Oncology, University of the Free State, Universitas Hospital, Bloemfontein, South Africa
| | - Marc Hendricks
- Department of Paediatrics and Child Health, Haematology-Oncology Service, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Yasmin Goga
- Department of Paediatrics and Child Health, Haematology-Oncology Service, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Amy Carr
- Pediatric Haematology-Oncology, University of KwaZulu-Natal Durban, Greys Hospital, Pietermaritzburg, South Africa
| | - Beverley Neethling
- Pediatric Haematology-Oncology, University of KwaZulu-Natal Durban, Inkosi Albert Luthuli Hospital and Greys Hospital, Pietermaritzburg, South Africa
| | - Artsiom Hramyka
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Fareed Omar
- Pediatric Haematology-Oncology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Rema Mathew
- Pediatric Haematology-Oncology, Walter Sisulu University, Frere Hospital, East London, South Africa
| | - Lizette Louw
- Centre of Molecular Imaging and Theranostics, Johannesburg, South Africa
| | - Thanushree Naidoo
- Department of Radiation Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Thandeka Ngcana
- Pediatric Haematology-Oncology, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | | | - Vutshilo Netshituni
- Pediatric Haematology-Oncology, University of Limpopo, Polokwane-Mankweng Hospital Complex, Polokwane, South Africa
| | - Elelwani Madzhia
- Pediatric Haematology-Oncology, Sefako Makgatho University, Dr George Mukhari Hospital, Garankuwa, South Africa
| | - Liezl du Plessis
- Pediatric Haematology-Oncology, University of the Free State, Kimberley Hospital, Kimberley, South Africa
| | - Tom Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Daynia E Ballot
- School of Clinical Medicine, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | | |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | |
Collapse
|