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[A multicenter study on childhood Hodgkin lymphoma treated with HL-2013 regimen in China]
1Department of Pediatric Hematology and Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Insights
The HL-2013 regimen effectively treats pediatric Hodgkin lymphoma (HL), achieving a high remission rate. However, high-risk patients and those not achieving early complete remission (CR) face increased recurrence risk, indicating a poorer prognosis.
Area of Science:
- Pediatric Oncology
- Hematologic Malignancies
- Clinical Trial Analysis
Background:
- Hodgkin lymphoma (HL) is a significant cancer in children.
- Evaluating treatment efficacy and prognostic factors is crucial for improving outcomes in pediatric HL.
Purpose of the Study:
- To assess the effectiveness of the HL-2013 treatment regimen in pediatric Hodgkin lymphoma.
- To identify key prognostic indicators for childhood HL.
Main Methods:
- Retrospective analysis of 145 newly diagnosed pediatric HL patients treated with the HL-2013 regimen.
- Utilized histopathological, immunohistochemical, and clinical data.
- Employed Kaplan-Meier survival analysis and Log-rank tests for statistical evaluation.
Main Results:
- The HL-2013 regimen achieved a first-line complete remission (CR) rate of 93.8%.
- Five-year overall survival (OS) and event-free survival (EFS) rates were 95.3% and 84.2%, respectively.
- Advanced stages (III-IV), high-risk stratification, and absence of early CR were associated with significantly worse survival outcomes.
Conclusions:
- The HL-2013 regimen demonstrates significant efficacy in treating pediatric Hodgkin lymphoma.
- Patients in high-risk groups and those not achieving early CR are more susceptible to disease recurrence or progression.
- Stage III-IV disease and lack of early CR are indicators of a poorer prognosis in pediatric HL.
Abstract:
Objective: To evaluate the efficacy of the Hodgkin lymphoma (HL)-2013 regimen in the treatment of children with HL, and to investigate the prognostic factors of childhood HL. Methods: Clinical data of 145 children (aged ≤18 years) with newly diagnosed HL, treated with HL-2013 regimen in 8 tertiary referral centers for childhood cancer from August 2011 to April 2021 were analyzed retrospectively. All the diagnosis were confirmed by histopathological morphology and immunohistochemical examination. The clinical characteristics and treatment outcomes were summarized, and the patients were divided into different groups according to clinical characteristics. Kaplan-Meier method was used for survival analysis, and the comparison of survival rates between groups was performed with Log-rank test. Results: Of the 145 cases, there were 115 males and 30 females, the age at diagnosis was 7.9 (5.8, 10.6) years. Cervical lymph node enlargement (114 cases, 78.6%) was the common symptom of the disease, and 57 patients (39.3%) were accompanied by large masses. The most common pathological classification was mixed cell type (93 cases, 64.1%). According to the Ann Arbor staging system, there were 9 cases of stage Ⅰ, 62 cases of stage Ⅱ, 45 cases of stage Ⅲ, 29 cases of stage Ⅳ. According to the risk stratification: there were 14 cases of low-risk group, 76 cases of medium-risk group and 55 cases of high-risk group. Of all patients, 68 cases (46.9%) achieved an early complete remission (CR) after 2 courses of chemotherapy, and the CR rate was 93.8% (136/145) after first-line treatment. Disease recurrence or progression occurred in 22 cases (15.2%). Of all patients, 125 cases survived, 6 cases died and 14 cases were lost to follow-up. Among the survived cases, 123 cases were continuously at CR state,and the follow-up time was 55 (40, 76) months. The 5-year overall survival (OS) and event free survival (EFS) rates were (95.3±1.9)% and (84.2±3.0)% for the entire group, respectively. 5-year OS and EFS rates for patients with stage Ⅲ-Ⅳ were both lower than those for patients with stage Ⅰ-Ⅱ (χ2=6.28 and 7.58, both P<0.05), the 5-year OS and EFS rates for patients in high-risk group were both lower than those for patients in low-risk and medium-risk group (χ2=10.93, 7.79, both P<0.05). The 5-year OS rates for the patient with early CR and without early CR were 100.0% and (90.9±3.6)% (χ2=5.77, P=0.016). EFS rates for the patient with early CR (68 cases) and without early CR (77 cases) were (93.8±3.0)% and (75.8±5.0)% (χ2=8.78, P=0.003). Conclusions: HL-2013 regimen is significantly effective in the treatment of pediatric HL. However, the patients in high-risk group and those without early CR are prone to disease recurrence or progression. Stage Ⅲ-Ⅳ and without early CR were associated with worse prognosis.
