Pediatric Hodgkin Lymphoma
P. C. Patra1, A. Phukan1, P. Chakrabarti2, P. K. Mandal3, T. K. Dolai2, R. De4, S. Baul5
1 Post Doctoral Trainee, 2 Professor, Department of Hematology, NRS Medical College, Kolkata, India, 3 Assistant Professor, Department of Hematology, NRS Medical College, Kolkata, India, 4 Associate Professor, Department of Hematology, NRS Medical College, Kolkata, India, 5 Clinical Tutor, Department of Hematology, NRS Medical College, Kolkata, India
Introduction: The cure rate of Hodgkin lymphoma (HL) in children and adolescents has steadily improved over the years but at the price of serious long-term toxicities. Therefore, the therapeutic paradigm has shifted towards reducing treatment-associated toxicities while maintaining high cure rates.
Objectives: To assess the response rate of GPOH HD-2002 study protocol in case of pediatric HL (up to 18 years of age) both as upfront as well as salvage therapy and to compare it with that of matched historical patient cohort treated with ABVD.
Material and Methods: All consecutive cases of pediatric Classical HL patients (up to 18 years of age) attending NRS Medical College from October 2014 to April 2018 were treated with GPOH HD-2002 protocol (OPPA/COPP for girls & OEPA/COPDAC for boys), the result of which was compared with the retrospective cohort treated with ABVD protocol from July 2009 to October 2014.
Results: Seventy-four cases of pediatric CHL were treated, among whom 22 were treated with GPOH HD-2002 protocol and were compared with retrospective cohort of 52 cases given ABVD. Median age was 7.5 years (range: 3–16) in the GPOH arm & 9.5 years (range: 3–18) in the ABVD arm. In the former arm, male: female ratio was 2:1 while in the latter group it was 5.5:1. Cervical lymphadenopathy was the most common clinical finding during initial presentation (82% and 89% in respective groups) either alone or with other lymph node regions. Eighteen (82%) belonged to advanced stages in the former and 31 (60%) in the latter group, while B symptom accompanied the advanced -stages in both (47% and 61% respectively). In the GPOH group, 16 have completed treatment & overall response was seen in 16 (100%) cases, among whom 14 (87.5%) had CR; two (12.5%) had PR. Out of those who went to CR, two patients (12.5%) relapsed, among which after 2nd line chemotherapy only one went to CR. Among those who received ABVD as upfront, overall response was seen in 39 (89%) cases, among which 34 (77%) had CR and 5 (11%) had PR and 5 (11%) had progressive disease. Two patients (4.5%) relapsed after 2years of achieving CR. Chemotherapy was given in a day care facility where nearly 60 patients per day were treated in 10 beds on a bed sharing basis. Table No.1 shows patient assessment parameters.
Conclusions: The GPOH HD-2002 protocol when given as upfront, the response rates are not inferior compared to ABVD. Due to the lower long-term toxicity, it may be a preferred regimen for pediatric patients.