title: Improving the prognosis of pediatric Hodgkin lymphoma in developing countries: a Moroccan Society of Pediatric Hematology and Oncology study.
abstract: BACKGROUND
  The event-free survival (EFS) of children with Hodgkin lymphoma (HL) exceeds 80% in high income countries (HIC), but little is known about this rate in developing countries.
  
  
  METHODS
  A prospective national protocol for children with classical HL was implemented in Morocco to increase EFS by careful risk stratification, providing each cycle of therapy on time, decreasing treatment abandonment, improving communication among healthcare providers, and improving data collection. Patients were stratified into a favorable risk group (Ann Arbor stages I and II, no B symptoms, no bulky disease, and no contiguous (E) lesions) and received four cycles of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) or an unfavorable risk group (all others) who received two cycles of vincristine, procarbazine, prednisone, and doxorubicin (OPPA) and four cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP). All patients received involved-field radiotherapy 25.5 Gy after completion of chemotherapy. EFS was calculated counting death, relapse/resistant disease, and abandonment as events.
  
  
  RESULTS
  From February 2004 to December 2007, 160 patients enrolled; 138 (86%) had unfavorable risk features. Twenty patients (12.5%) abandoned treatment, 16 relapsed or had resistant disease, and 6 died (3 unexplained, 2 varicella, and 1 suicide). The estimated 5-year EFS was 70 ± 4% and overall survival 88 ± 3%.
  
  
  CONCLUSIONS
  Good outcomes for pediatric HL patients can be achieved in LMIC using a multidisciplinary team approach, uniform protocol-based therapy, twinning partnership among oncology units in-country and abroad, and a data collection system to monitor compliance and identify gaps in care.
authors.affiliation: Pediatric Hematology and Oncology Center, Rabat, Morocco. lailahsn@gmail.com
authors.forename: Laila
authors.initials: L
authors.lastname: Hessissen
authors.forename: Rachida
authors.initials: R
authors.lastname: Khtar
authors.forename: Abdellah
authors.initials: A
authors.lastname: Madani
authors.forename: Maria
authors.initials: M
authors.lastname: El Kababri
authors.forename: Amina
authors.initials: A
authors.lastname: Kili
authors.forename: Mhamed
authors.initials: M
authors.lastname: Harif
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khattab
authors.forename: Souha
authors.initials: S
authors.lastname: Sahraoui
authors.forename: Nouredine
authors.initials: N
authors.lastname: Benjaafar
authors.forename: Samir
authors.initials: S
authors.lastname: Ahid
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Said
authors.initials: S
authors.lastname: Benchekroun
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D058015:Health Communication; D006405:Hematology; D006689:Hodgkin Disease / Q000401:mortality* / Q000628:therapy*; D008727:Methotrexate / Q000008:administration & dosage; D009018:Morocco / Q000453:epidemiology; D010349:Patient Compliance; D010372:Pediatrics; D011344:Procarbazine / Q000008:administration & dosage; D011446:Prospective Studies; D012189:Retrospective Studies; D012955:Societies, Medical; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D011344:Procarbazine; D014750:Vincristine; D004317:Doxorubicin; D008727:Methotrexate
keywords: Hodgkin lymphoma; abandonment; childhood; low income countries; morocco