Impact of using combined chemotherapy regimen in children with Hodgkin lymphoma in countries with limited resources: a single center experience in Iraq
Main Article Content
Keywords
Hodgkin lymphoma, developing countries, combined chemotherapy
Abstract
Objective/Background: Data about Hodgkin lymphoma (HL) in developing countries are scattered. The aim of this study is to present clinical features and outcome of children with HL using combined different chemotherapy regimens. Response-based approach was applied irrespective of risk stratification.
Methods: Patients aged 18 years and younger who were diagnosed with HL between January 2014 and December 2021 in a cancer center in Iraq, were recruited. Patients were stratified into three risk groups. Initial treatment with induction chemotherapy (i.e., 2 cycles of ABVD) was applied to all patients. Patients who achieved complete radiological response to induction chemotherapy continued with 4-6 cycles of ABVD; radiotherapy was omitted. Patients with slow early response received 3 cycles of COPDac after 3rd cycle of ABVD, followed by radiotherapy.
Results: fifty-nine patients were enrolled in this study. The median age was 7 years. Twenty (33.9%) patients were stage III, followed by stage II (32.2%). Twenty-five patients had B symptoms. Initial splenic involvement was found in 11 patients. Approximately one third of patients had bulky disease (n = 19; 32.2%). The most common histology was mixed cellularity (n = 44). The median follow-up was 2.7 year (range from 0.1 to 7.5 years). The 5-year estimates of survival and EFS were 92% and 78% ±10%, respectively. Only bulky disease had a significant negative influence on the outcome.
Conclusion: Good outcomes for pediatric HL patients can be achieved in low and middle income countries. Response-based therapy approach is feasible to reduce long term treatment-related sequel.
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Oncol., vol. 4, no. Supplement 2, 2018, doi: 10.1200/jgo.18.20400.
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3, no. 5, 2017, doi: 10.1200/JGO.2016.005314.
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vol. 26, no. 3, pp. 967–973, Mar. 2018, doi: 10.1007/s00520-017-3917-z.
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FRENCH-AFRICAN pediatric oncology group (GFAOP) experience,” Pediatr. Blood Cancer, vol. 62, 2015.
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Vietnam,” BMJ Open, vol. 9, no. 8, 2019.
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Chemotherapy Alone with Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma,” JAMA Oncol., vol. 5, no. 5, 2019, doi:
10.1001/jamaoncol.2018.5911.
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Group report,” Pediatr. Blood Cancer, vol. 64, no. 12, 2017, doi: 10.1002/pbc.26681.
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Developing Countries: Children Cancer Hospital Egypt Experience,” Blood, vol. 128, no. 22, 2016, doi: 10.1182/blood.v128.22.4156.4156.
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Involved-Field Radiation Therapy (IFRT) Based on Prognosis at Diagnosis and Early Response: Results from Pediatric Argentinian Collaborative
Group Gatla Study for Children and Adolescents with Hodgkin Lymphoma,” Blood, vol. 136, no. Supplement 1, 2020, doi: 10.1182/blood-2020-
135945.
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lymphoma’s in Bahrain,” Tropical and Geographical Medicine, vol. 33, no. 1. pp. 42–48,1981.
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experience reduced overall survival: a National Cancer DataBase study,” Leukemia and Lymphoma, vol. 60, no. 7. pp. 1656–1667, 2019,
doi: 10.1080/10428194.2018.1546855.
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Incidence,” Clinical Lymphoma, Myeloma and Leukemia, vol. 20, no. 10. pp. 668-676.e5, 2020, doi: 10.1016/j.clml.2020.05.010.
24. “Hodgkin lymphoma in childhood: clinicopathological features and therapy outcome at 2 centers from a developing country.,”
Medicine. p. 25881843, 2015.
25. W. Memon, A. Samad, and G. M. Sheikh, “Hodgkins lymphoma in cervical lymphadenopathy,” Pakistan Journal of Medical
Sciences, vol. 24, no. 1. pp. 118–121, 2008.
26. T. Ghafoor, “Prognostic factors in pediatric Hodgkin lymphoma: experience from a developing country,” Leuk. Lymphoma, vol. 61,
no. 2, 2020, doi: 10.1080/10428194.2019.1665666.
27. A. S. Dongre et al., “Analysis of prognostic factors in childhood advanced stage Hodgkin lymphoma: A retrospective study.,” Journal of
Clinical Oncology, vol. 32, no. 15_suppl. pp. e21000–e21000, 2014, doi:10.1200/jco.2014.32.15_suppl.e21000.
28. S. Büyükkapu-Bay, F. Çorapçıoğlu, G. Aksu, Y. Anık, H. Demir, and C. Erçin, “Prognostic factors and treatment results of pediatric Hodgkin’s
lymphoma: A single center experience,” Turk. J. Pediatr., vol. 57, no. 4, pp. 359–366, 2015.
29. L. S. Arya, V. Dinand, S. Bakhshi, V. Thavaraj, R. Singh, and R. Dawar, “Significance of splenomegaly in childhood Hodgkin disease,”
Journal of Pediatric Hematology/Oncology, vol.26, no. 12. pp. 807–812, 2004.
30. A. Belgaumi et al., “Clinical characteristics and outcome of pediatric patients with stage IV Hodgkin lymphoma,” Hematology/ Oncology
and Stem Cell Therapy, vol. 2, no. 1. pp. 278–284, 2009, doi: 10.1016/S1658-3876(09)50038-6.
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Mar 13, 2023
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Usama Al-Jumaily, Haider Yousif Shukur, Mohammed Fawzi, Mohammed Jawad, Rasha AlSafi, Sabah Al-mosawy, Sabah Al-mosawy, & Monika Metzger. (2023). Impact of using combined chemotherapy regimen in children with Hodgkin lymphoma in countries with limited resources: a single center experience in Iraq. Journal of Population Therapeutics and Clinical Pharmacology, 30(3), 659-668. https://doi.org/10.47750/jptcp.2023.30.03.067
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All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Usama Al-Jumaily, Haider Yousif Shukur, Mohammed Fawzi, Mohammed Jawad, Rasha AlSafi, Sabah Al-mosawy, Sabah Al-mosawy, & Monika Metzger. (2023). Impact of using combined chemotherapy regimen in children with Hodgkin lymphoma in countries with limited resources: a single center experience in Iraq. Journal of Population Therapeutics and Clinical Pharmacology, 30(3), 659-668. https://doi.org/10.47750/jptcp.2023.30.03.067