TITLE:
Risk-Adapted, Combined-Modality Therapy for Unfavorable Pediatric Hodgkin Lymphom
AUTHORS:
Amany M. Ali, Amira M. Mohamed, Shimaa Ahmed, Mohamed Abdallah, Tarek M. Alsaba, Samar Mansour
KEYWORDS:
Risk-Adapted, Combined-Modality, Unfavourable Pediatric Hodgkin Lymphoma
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.9 No.7,
July
10,
2018
ABSTRACT: Background
and Objectives: Risk-adapted therapy for children with HL is directed toward high
survival, minimal toxicity and optimal quality of life, with long term follow
up. We assess the impact of prognostic factors associated with local treatment
failure of pediatric HL patients with unfavorable criteria treated with
combined modality: Alternating ABVD (Doxorubicin, Bleomycin, Vinblastine and
Decarbazine) and COEP (Cyclophosphamide, Oncovin, Etoposide and Prednisone)
chemotherapy and response-based, involved-field radiation for newly diagnosed
unfavorable pediatric HL patients, also will detect toxicities and long-term
complications observed in the patients. Methods: This prospective study
was carried out from January 2010 to January 2018, with a median follow up of
74 months (range 8 - 103 months). 54 patients were eligible for this study
stratified into two groups: intermediate risk (IR) and high-risk group (HR). Patients were treated with (4 - 6
cycles) and (6 - 8 cycles) respectively of alternating ABVD/COEP chemotherapy
followed by involved-field radiation therapy (IFRT): 15 Gy for patients
achieved complete response, and 25.5 Gy for those achieved a partial response. Results: 27 patients were IR and 27 patients were
HR. There were 16 treatment failures; 5 patients had progressive disease; and
11 patients had a relapse. 9 patients died from their disease progression. The
5-year overall survival (OS) and event-free survival (EFS) rates (±SE) were
81.8% ± 5.7% and 71.8% ± 6.2% respectively. Multivariate analysis revealed that
the only independent factor for inferior OS was radiotherapy. Conclusion: Treatment results of unfavourable HL patients in our study are satisfactory
for with IR group but not for HR group who needs intensification of therapy.
Radiotherapy is considered as a cornerstone in the treatment of the patients
with unfavourable criteria with better assessment of early responders needed by
PET-CT to identify patients at risk for relapse.