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Prognostic factors in pediatric Hodgkin lymphoma: experience from a developing country
1Armed Forces Bone Marrow Transplant Centre, CMH Medical Complex, Rawalpindi, Pakistan.
Insights
Delayed treatment initiation significantly impacts survival in pediatric Hodgkin lymphoma, especially in low- and middle-income countries. Early diagnosis and prompt therapy are crucial for improving outcomes in children with this curable cancer.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Pediatric Hodgkin lymphoma is a curable cancer in children.
- Prognostic factors can differ between high-income and low- to middle-income countries.
- Understanding these factors is crucial for optimizing treatment strategies.
Purpose of the Study:
- To identify prognostic factors influencing survival in pediatric Hodgkin lymphoma.
- To analyze the impact of treatment delays and other clinical variables on patient outcomes.
- To provide insights relevant to resource-limited settings.
Main Methods:
- Retrospective analysis of data from 106 children diagnosed with Hodgkin lymphoma.
- Evaluation of clinical characteristics including age, sex, B symptoms, disease stage, and treatment details.
- Univariate and multivariate analyses were performed to determine significant prognostic factors for overall survival (OS) and event-free survival (EFS).
Main Results:
- A significant proportion of patients (55.7%) presented with B symptoms.
- Univariate analysis identified delayed treatment start, anti-tuberculosis therapy, nutritional status, B symptoms, histological subtype, bone marrow, and pulmonary involvement as significant factors affecting OS.
- Multivariate analysis confirmed that a delay in therapy initiation exceeding one year was a significant adverse prognostic factor. Event-free survival (EFS) and overall survival (OS) were 80.2% and 91.5%, respectively.
Conclusions:
- Delayed treatment initiation is a critical adverse prognostic factor for pediatric Hodgkin lymphoma, particularly in resource-limited settings.
- Prompt diagnosis and timely commencement of therapy are essential for improving survival rates.
- Further research and improved healthcare infrastructure are needed to address disparities in outcomes.
Abstract:
Pediatric Hodgkin lymphoma is a curable malignancy. The prognostic factors in the low- and middle-income countries are different from the high-income countries. Data of 106 children, including 84 (79.2%) boys and 22 (20.8%) girls were examined. The mean age at presentation was 7.55 ± 2.74 years. Fifty-nine (55.7%) cases had B symptoms. Stage I disease was documented in 11 (10.4%) cases, stage II in 34 (32.1%), stage III in 43 (40.6%), and stage IV in 18 (17%) cases. In univariate analysis, delayed start of treatment (p ≤ .001), anti-tuberculosis therapy (p ≤ .001), nutritional status (p = .006), B symptoms (p = .036), histological subtype (p ≤ .001), bone marrow (p = .001), and pulmonary involvement (p = .001), significantly affected overall survival (OS). The multivariate model demonstrated that a delay in therapy initiation of more than one year was a significant adverse factor. With a median follow-up time of 36.26 ± 27.47 months, EFS and OS was 80.2% and 91.5% respectively.
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