TY - JOUR
T1 - Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa
AU - Geel, Jennifer
AU - van Zyl, Anel
AU - Plessis, Jan du
AU - Hendricks, Marc
AU - Goga, Yasmin
AU - Carr, Amy
AU - Neethling, Beverley
AU - Hramyka, Artsiom
AU - Omar, Fareed
AU - Mathew, Rema
AU - Louw, Lizette
AU - Naidoo, Thanushree
AU - Ngcana, Thandeka
AU - Schickerling, Tanya
AU - Netshituni, Vutshilo
AU - Madzhia, Elelwani
AU - du Plessis, Liezl
AU - Kelsey, Tom
AU - Ballot, Daynia E.
AU - Metzger, Monika L.
N1 - Publisher Copyright:
© 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.
PY - 2024/1
Y1 - 2024/1
N2 - Background: Historic South African 5-year overall survival (OS) rates for Hodgkin lymphoma (HL) from 2000 to 2010 were 46% and 84% for human immunodeficiency virus (HIV)-positive and HIV-negative children, respectively. We investigated whether a harmonised treatment protocol using risk stratification and response-adapted therapy could increase the OS of childhood and adolescent HL. Methods: Seventeen units prospectively enrolled patients less than 18 years, newly diagnosed with classical HL onto a risk-stratified, response-adapted treatment protocol from July 2016 to December 2022. Low- and intermediate-risk patients received four and six courses of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), respectively. High-risk patients received two courses of ABVD, followed by four courses of cyclophosphamide, vincristine, prednisone, and dacarbazine (COPDac). Those with a slow early response and bulky disease received consolidation radiotherapy. HIV-positive patients could receive granulocyte colony-stimulating factor and less intensive therapy if stratified as high risk, at the treating clinician's discretion. Kaplan–Meier survival analysis was performed to determine 2-year OS and Cox regression to elucidate prognostic factors. Results: The cohort comprised 132 patients (19 HIV-positive, 113 HIV-negative), median age of 9.7 years, with a median follow-up of 2.2 years. Risk grouping comprised nine (7%) low risk, 36 (27%) intermediate risk and 87 (66%) high risk, with 71 (54%) rapid early responders and 45 (34%) slow early responders, and 16 (12%) undocumented. Two-year OS was 100% for low-risk, 93% for intermediate-risk, and 91% for high-risk patients. OS for HIV-negative (93%) and HIV-positive (89%) patients were similar (p =.53). Absolute lymphocyte count greater than 0.6 × 109 predicted survival (94% vs. 83%, p =.02). Conclusion: In the first South African harmonised HL treatment protocol, risk stratification correlated with prognosis. Two-year OS of HIV-positive and HIV-negative patients improved since 2010, partially ascribed to standardised treatment and increased supportive care. This improved survival strengthens the harmonisation movement and gives hope that South Africa will achieve the WHO Global Initiative for Childhood Cancer goals.
AB - Background: Historic South African 5-year overall survival (OS) rates for Hodgkin lymphoma (HL) from 2000 to 2010 were 46% and 84% for human immunodeficiency virus (HIV)-positive and HIV-negative children, respectively. We investigated whether a harmonised treatment protocol using risk stratification and response-adapted therapy could increase the OS of childhood and adolescent HL. Methods: Seventeen units prospectively enrolled patients less than 18 years, newly diagnosed with classical HL onto a risk-stratified, response-adapted treatment protocol from July 2016 to December 2022. Low- and intermediate-risk patients received four and six courses of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), respectively. High-risk patients received two courses of ABVD, followed by four courses of cyclophosphamide, vincristine, prednisone, and dacarbazine (COPDac). Those with a slow early response and bulky disease received consolidation radiotherapy. HIV-positive patients could receive granulocyte colony-stimulating factor and less intensive therapy if stratified as high risk, at the treating clinician's discretion. Kaplan–Meier survival analysis was performed to determine 2-year OS and Cox regression to elucidate prognostic factors. Results: The cohort comprised 132 patients (19 HIV-positive, 113 HIV-negative), median age of 9.7 years, with a median follow-up of 2.2 years. Risk grouping comprised nine (7%) low risk, 36 (27%) intermediate risk and 87 (66%) high risk, with 71 (54%) rapid early responders and 45 (34%) slow early responders, and 16 (12%) undocumented. Two-year OS was 100% for low-risk, 93% for intermediate-risk, and 91% for high-risk patients. OS for HIV-negative (93%) and HIV-positive (89%) patients were similar (p =.53). Absolute lymphocyte count greater than 0.6 × 109 predicted survival (94% vs. 83%, p =.02). Conclusion: In the first South African harmonised HL treatment protocol, risk stratification correlated with prognosis. Two-year OS of HIV-positive and HIV-negative patients improved since 2010, partially ascribed to standardised treatment and increased supportive care. This improved survival strengthens the harmonisation movement and gives hope that South Africa will achieve the WHO Global Initiative for Childhood Cancer goals.
KW - GICC
KW - Hodgkin lymphoma
KW - South Africa
KW - adolescent
KW - child
KW - harmonisation
UR - http://www.scopus.com/inward/record.url?scp=85173750872&partnerID=8YFLogxK
U2 - 10.1002/pbc.30712
DO - 10.1002/pbc.30712
M3 - Article
C2 - 37814417
AN - SCOPUS:85173750872
SN - 1545-5009
VL - 71
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
IS - 1
M1 - e30712
ER -
