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Pediatric patients with Hodgkin lymphoma should be treated according to risk- and response-adaptive care principles, according to a recent study.

Hodgkin lymphoma (HL) is the most prevalent cancer in young adults, making up about 40% of all lymphomas in children. HL is also one of the most treatable cancers, with about an 80% cure rate when treated with chemotherapy and radiation. 

A study published in the Journal of the Egyptian National Cancer Institute evaluated the effectiveness of risk- and response-adjusted therapy for pediatric HL patients and the association between various prognostic factors and outcomes.

Participants Characteristics

The study consisted of 69 participants, comprising 57 males and 12 females. The mean age of the participants was 8 years, with a range of 3 to 17 years. The study sample consisted of individuals who were selected from a pool of patients who had received a diagnosis of classic HL.

Distribution of Hodgkin Lymphoma Subtypes and Staging
The most common subtype was nodular sclerosis (33 cases; 47.8%), followed by mixed cellularity (29 cases; 24.1%) and lymphocyte-rich (3 cases; 5.8%). Four patients (5.7%) had typical HL, but no pathological subgroup was established. Stage IV was the most prevalent (24 cases; 34.8%), followed by stage I (21 cases; 30.4%), stage III (12 cases; 17.4%), and stage II (12 cases; 17.4%). Advanced stages (settings III and IV) comprised 52% of cases, while early stages comprised 48%.

Early Response to ABVD (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine)

Nine patients (13%) had a slow early response (SER) (residual PET-CT uptake) after two rounds of ABVD (doxorubicin: 25 mg/m2, bleomycin: 10 U/m2, vinblastine: 6 mg/m2, and dacarbazine: 375 mg/m2). In comparison, the vast majority (60 patients, 89%) had a rapid early response (RER) (complete response with PET-CT negative after the second cycle of ABVD). Low risk (27 patients; 39.1%), intermediate risk (15 patients; 21.7%), and high risk were noted.

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Outcomes and Survival Rates in Lymphoma Patients
Eight patients (11.6%) relapsed, three (4.3%) had refractory disease, three (4.3%) had early relapses, and two (2.9%) had late recurrences. Three patients achieved remission after the second line of therapy. At the same time, five received the third line, of whom three received  dexamethasone, cytarabine, and Platinol; one underwent therapy with ifosfamide, carboplatin, and etoposide; and one received vinorelbine and gemcitabine. At 3 years, overall and event-free survival were 91.9% and 83.6%, respectively.

Response to Treatment and Pet Scan Results

After treatment, 6 of 9 patients had a negative PET scan, indicating a complete response, whereas 3 received salvage chemotherapy due to disease refractoriness.

Ali, N., Mansour, M. A., Khalil, E., & Ebeid, E. (2023). Outcome and prognostic factors of pediatric patients with Hodgkin lymphoma: a single-center experience. Journal of the Egyptian National Cancer Institute, 35(1). https://doi.org/10.1186/s43046-023-00189-w