Abstract P073

Outcomes of Pediatric Hodgkin Lymphoma Patients treated with ABVD Regimen. A retrospective Cohort Study

Background: Hodgkin lymphoma (HL) a highly curable malignancy has a peak incidence in adolescent and young adults. Chemotherapy regimen ABVD and involved field radiotherapy (IFRT) is the gold-standard treatment for early and advanced stages of HL in adults. Aim of the study To analyze data of patients who received first line chemotherapy ABVD and IFRT at the Children Cancer Hospital Egypt 57357 (CCHE) over 12 years period.

Methodology: A retrospective analysis including all patients, < 18 years, diagnosed and treated as classic HL during the period from 2007-2019. Patients were stratified as low (stage IA/IB/IIA with ESR<30 and without bulky disease), intermediate (stage IEA/IEB/IIA/IIIA with ESR ≥ 30 or with bully disease), and high risk (stage IIBE/IIIAE/IIIB/IV) disease. Chemotherapy consisted of 4 cycles for low, and 6 for intermediate and high risk patients, followed by IFRT total dose 1,980 Gy. The median follow up period was 105 months (range 6- 217 months).

Results: This study included 1378 patients. Their median age was 9.3 years. The majority (70%) were from 5-15 years. There was a strong male predominance accounting for 72%. The most common pathologic subtype was nodular sclerosis (54%), followed by mixed cellularity (38%). Stage 2A was he most common (31%). Low risk patients were the most common (46%), followed by high risk (31%). Two hundred thirteen patients (15.4 %) had relapse (187, 13.5%) or refractory (26, 0.18%) disease. Following salvage chemotherapy, 123 (8.9%) patients received a hematopoietic stem cell transplant (HSCT), mainly (98%) autologous. The 5 years overall survival (OS) for the entire cohort was 95.3% (95% CI 94.2%-96.4%), while the 5 years progression free survival (PFS) probability was 86.7% (95% CI 84.9% -88.5%). The 5 years PFS for low risk group was 94.2%, compared to 86.8% for intermediate risk and 75.6% for high risk patients (P<0.001). Second malignant neoplasm (SMN) was detected in 31 patients (0.22) mainly cancer thyroid (58%). One hundred patients (7.2%) died, mainly from disease progression including 28 post HSCT and 6 post SMN.

Summary and conclusion: ABVD regimen at our institution has an excellent outcome. late effects of therapy, include an elevated risk for SMN, cardio toxicity, pulmonary toxicity, and endocrine dysfunction. Recently, new treatment strategies have been developed to balance the intensity of therapy needed to maintain disease-free survival while simultaneously preserving overall survival.