title: Outcome of pediatric advanced Hodgkin lymphoma treated with ABVD and predictors of inferior survival: a multicenter study of 186 patients.
abstract: Clinical stage alone is used for risk stratification in treatment of pediatric advanced Hodgkin lymphoma (HL). To identify other risk factors, we collected data from three tertiary centers on 186 patients with advanced stage (IIB-IV) consecutively treated with Adriamycin, bleomycin, vinblastine, Dacarbazine (ABVD) chemotherapy ± radiotherapy. Freedom from treatment failure (FFTF) and overall survival (OS) were end points. With median follow-up period of 57.9 months (range: 1-151 months), five-year FFTF and OS was 84.8% (95% CI 78.6-89.3%) and 95.3% (95% CI 90.78-97.6%), respectively. We identified stage-4 [HR-3.6(1.25, 9.97); p = .017], high total leukocyte count (>15,000/mm3) [HR-2.6(1.3,8.1); p = .008] and lymphopenia (lymphocyte count ≤8%) [HR-4.9(1.7,14.1); p = .002] predictive of inferior FFTF. Patients with none or one of these risk factors had significantly better five-year FFTF (91.9%) as compared to those with risk factors (two risk factor [74.7%; p = .001]; 3,4 risk factors [14.3%; p < .0001]). Patients without these risk factors can be treated with ABVD and may not need intensive therapy.
authors.affiliation: a Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital , All India Institute of Medical Sciences , New Delhi , India.
authors.forename: Sainath
authors.initials: S
authors.lastname: Bhethanabhotla
authors.affiliation: b Department of Pediatric Haematology and Oncology , Rajiv Gandhi Cancer Institute and Research Centre , New Delhi , India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Jain
authors.affiliation: b Department of Pediatric Haematology and Oncology , Rajiv Gandhi Cancer Institute and Research Centre , New Delhi , India.
authors.forename: Gauri
authors.initials: G
authors.lastname: Kapoor
authors.affiliation: c Department of Pediatric Oncology , Indraprastha Apollo Hospital , New Delhi , India.
authors.forename: Amita
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: d Department of Laboratory Oncology , Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences , New Delhi , India.
authors.forename: Anita
authors.initials: A
authors.lastname: Chopra
authors.affiliation: e Department of Biostatistics , All India Institute of Medical Sciences , New Delhi , India.
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Vishnubhatla
authors.affiliation: a Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital , All India Institute of Medical Sciences , New Delhi , India.
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D001761:Bleomycin / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003606:Dacarbazine / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin
keywords: ABVD; pediatric Hodgkin lymphoma; risk factor