Pediatric Hodgkin Lymphoma Treated at Cancer Institute, Chennai, India: Long-Term Outcome

Abstract

PurposePediatric 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.MethodsWe 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.ResultsThe 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).ConclusionOverall, the outcomes of patients treated at our center are comparable to those observed in other centers in India and globally.

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

“…ABVD and COPP-ABV continue to be used as common chemotherapy regimens in pediatric HL. 7 , 30 The question of whether one can use interim PET response to eliminate RT in children treated with these regimens can only be answered by pediatric trials conducted on the basis of the same chemotherapy regimens.…”

“…Our treatment guidelines recommend RT in all patients with bulky disease at presentation. 7 Following the availability of PET for interim response assessment, we considered the elimination of RT in patients with excellent metabolic response on interim PET, on a case-by-case basis. Despite treating a large proportion of our patients without RT, the EFS and OS were satisfactory.…”

“…Bone involvement was defined as FDG uptake correlated by tumor-typical correlation on CT. Four cycles of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy were administered to patients in groups 1 and 2. 7 , 8 Six cycles of cyclophosphamide, vincristine, prednisolone, procarbazine, doxorubicin, bleomycin, vinblastine (COPP-ABV) hybrid chemotherapy were administered to patients in group 3. 7 , 9 …”

“… 7 , 8 Six cycles of cyclophosphamide, vincristine, prednisolone, procarbazine, doxorubicin, bleomycin, vinblastine (COPP-ABV) hybrid chemotherapy were administered to patients in group 3. 7 , 9 …”

Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage

“…Childhood cancer care is only available at the tertiary level and since most functioning cancer centres are located in metropolitan cities, the rural sector remains deprived of this service [ 4 ]. This contributes to a delay in presentation where for example, it was found that 80% of children with neuroblastoma [ 5 ] and 40–60% of children with Hodgkin lymphoma [ 6 , 7 ] presented in advanced stages at treating hospitals.…”