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Clinical profile and outcome of classical Hodgkin lymphoma treated with a risk‐adapted approach in a tertiary cancer center in India
Author(s) -
Parambil Badira Cheriyalinkal,
Narula Gaurav,
Prasad Maya,
Shah Sneha,
Shet Tanuja,
Shridhar Epari,
Khanehal,
Laskar Siddhartha,
Gujral Sumeet,
Sankaran Hari,
Banavali Shripad
Publication year - 2020
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28058
Subject(s) - dacarbazine , medicine , abvd , vinblastine , bleomycin , etoposide , gastroenterology , oncology , hodgkin's lymphoma , chemotherapy , cyclophosphamide , surgery , vincristine
Background Classical Hodgkin lymphoma (cHL) has excellent survival rates, but late effects are an issue and dictate modern approaches. We analyzed the clinical profile and outcome of cHL treated on a risk‐adapted approach aimed at reducing late effects while improving historical outcomes at our center. Procedure Children (≤15 years) consecutively treated for cHL from January 2013 through December 2016 were retrospectively analyzed. 18 FDG‐PET‐CT–based staging and response assessment was done after two cycles for early response (ERA) and end of chemotherapy (late‐response assessment [LRA]) if not in complete response (CR; Deauville < 4) at ERA. Stages IA/IB/IIA were low risk (LR) and received two cycles of ABVD (adriamycin/bleomycin/vinblastine/dacarbazine). Stages IAX/IBX/IIAX/IIB/IIIA were intermediate risk (IR), and stages IIBE/IIBX/IIIAE/IIIAX/IIIB/IVA/IVB were high risk (HR). Both received two cycles of OEPA (oncocristine/etoposide/prednisolone/adriamycin). Those in ERA‐CR received two cycles of ABVD if LR, and two and four cycles of COPDac (cyclophosphamide/oncocristine/prednisolone/dacarbazine), respectively, for IR and HR. Involved‐field radiotherapy (IFRT) was given to bulky sites and ERA < CR. Those at LRA < CR (Deauville < 3) or progression at any stage received salvage regimens. Results In the study period, 126 patients were identified who received the above protocol. There were 12 LR, and 114 advanced staged Hodgkin lymphoma (AHL) (18, IR; 96, HR) of which 91 (79.8%) had bulky sites. Eight (66.6%) LR and 93 (83%) AHL patients achieved ERA‐CRs. IFRT was given to 4 (33.3%) LR patients with ERA < CR, and 92 (80.7%) of AHL (91 bulky sites; 1 ERA < CR). At a median follow‐up of 31 months (range, 17–62), three‐year event‐free survival (EFS) and overall survival (OS) were both 100% for LR, and 94.4% (95% CI, 66.0%–99.2%) for IR, whereas for HR it was 90.3% (95% CI, 82.2%–94.8%) and 92.6% (95% CI, 85.2%–96.4%), respectively. Conclusions Children with HL have favorable outcomes with manageable toxicities when treated on a risk‐stratified and adapted approach. A high proportion of AHL have bulky disease necessitating IFRT, a concern that will have to be factored in future strategies.