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Clinical Features and Treatment Outcomes of Children With Anaplastic Large Cell Lymphoma in Pakistan

A Multicenter Study

Resham, Shahzadi, MBBS, FCPS (Pediatric Hematology and Oncology)*; Khan, Rahil, MBBS, FCPS (Pediatric Hematology and Oncology); Ashraf, Shamvil, MBBS, DCH, FCPS, MRCP (Pediatrics); Rizvi, Arjumand, MPhil*; Altaf, Sadaf, MBBS, MD (Pediatric Hematology and Oncology)

Journal of Pediatric Hematology/Oncology: May 2019 - Volume 41 - Issue 4 - p 298–302
doi: 10.1097/MPH.0000000000001451
Original Articles

Background: Different approaches have been adopted in the treatment of anaplastic large cell lymphoma (ALCL); there is a lack of consensus with regard to standard treatment. Because of paucity of data from low and middle-income countries, we reviewed the clinical features and treatment outcomes of children with ALCL.

Methods: All ALCL patients under 16 years of age diagnosed from 2005 to 2015 at Aga Khan University Hospital and The Indus Hospital were identified. Clinical features and treatment outcomes were analyzed.

Results: Thirty-two (n=32) patients met the inclusion criteria. Cervical Lymphadenopathy was the most common presentation (34.3%, n=11). Advanced disease was seen in 68.7% (n=22) (stages III and IV). Fourteen (42.4%) were treated on ALCL-99, 30.3% (n=10) on multicenter protocol-842 regimen, 9% (n=3) on adriamycin-prednisolone-oncovin (doxorubicin, prednisone, vincristine) regimen, and 16% (n=5) were treatment abandonments. Five-year overall survival was 70.6% (95% confidence interval: 47.8%-84.9%), and 5-year event-free survival (EFS) considering treatment abandonment and death as an event was 52.3 % (95% confidence interval: 23.5%-74.8%).

Conclusions: Significant therapy-related mortality (27.7%) was observed. Treatment abandonment and therapy-related toxicity were the major barriers for better outcomes. However, less intensive outpatient regimens, such as adriamycin-prednisolone-oncovin regimen, may decrease the number of hospitalizations, hence reducing treatment abandonment in the low and middle-income country.

Departments of *Pediatric and Child Health

Oncology, Aga Khan University Hospital

Department of Pediatrics Hematology Oncology, The Indus Hospital, Karachi, Pakistan

S.R. and R.K. contributed equally.

The authors declare no conflict of interest.

Reprints: Sadaf Altaf, MBBS, MD (Pediatric Hematology and Oncology), Department of Oncology, American Board of Pediatric, Hematology and Oncology, Aga Khan University, Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan (e-mail:

Received June 8, 2018

Accepted January 15, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.