title: Comparison of Presentation and Outcome in 100 Pediatric Hodgkin Lymphoma Patients Treated at Children Hospital, Lahore, Pakistan and Royal Marsden Hospital, UK.
abstract: OBJECTIVE
  To compare differences in demographics and outcomes in childhood Hodgkin lymphoma (HL) presenting at the Children's Hospital Lahore (CHL), and Royal Marsden Hospital (RMH), UK.
  
  
  METHODS
  An observational comparative study.
  
  
  METHODS
  From January 2011 to February 2012 at CH, Lahore and from October 2008 to February 2012 at RMH, UK.
  
  
  METHODS
  Consecutive HL patients (50 from each hospital) were inducted. Data regarding age, gender, staging, histopathology and outcome were analysed. Clinical and pathological staging done according to Ann-Arbor and World Health Organization classification. Treatment duration was 6-8 months. They were followed for 6 months post-treatment. Frequencies of variables were noted and compared. Chi-square test was used for determining significance.
  
  
  RESULTS
  Patients from Children's Hospital, Lahore were younger (mean 7.9 years) with male predominance (n=42, 84%). Histopathology showed Mixed Cellularity (MC) in 32 (64%), Nodular Sclerosis (NS) in 5 (10%), Lymphocyte Rich in 4 (8%) and lymphocyte depleted in 1 (2%), nodular lymphocyte predominant (NLP) in 1 (2%) each. Majority presented in stage IV (n=25,50%), or stage III (n=20,40%). Constitutional B symptoms were present in 37 (74%). Bone marrow involvement observed in 23 (46%). Remission was achieved in 42 (84%) patients; 2 (4%) relapsed, 4 (8%) expired and 2 (4%) left against medical advice. In contrast, RMH patients were older (mean 11.8 years.) and 30 (60%) were males. NS (n=40,80%) and NLP (n=6,12%) types were predominant. Two (4%) patients were in stage I, 27 (54%) in stage II, 12 (24%) in stage III and 9 (18%) presented in stage IV. Fourteen (28%) had B-symptoms. None had bone marrow disease. Event free survival was 46 (92%). Four (8%) patients relapsed. Three responded to second line therapy and one relapsed postautologous transplant.
  
  
  CONCLUSIONS
  Significant differences were observed in age at presentation, stage, histopathology and extent of bone marrow involvement between the groups. Of interest is the bone marrow involvement in stage IV patients in Pakistan. Delayed diagnosis account for advanced stage but difference in pathological subtype needs further study.
authors.affiliation: Department of Paediatric Haematology/Oncology and Bone Marrow Transplant, Birmingham Children Hospital, Steel House Lane, B4 6NH Birmingham, UK.
authors.forename: Mahwish
authors.initials: M
authors.lastname: Faizan
authors.affiliation: Department of Paediatric Oncology, Royal Marsden Hospital, Downs Road, Sutton, London, UK SM2 5PT.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Taj
authors.affiliation: Department of Haematology/Oncology, The Children Hospital and ICH, Ferozepur Road, Lahore, Pakistan.
authors.forename: Saadia
authors.initials: S
authors.lastname: Anwar
authors.affiliation: Department of Haematology/Oncology, The Children Hospital and ICH, Ferozepur Road, Lahore, Pakistan.
authors.forename: Nyla
authors.initials: N
authors.lastname: Asghar
authors.affiliation: Department of Haematology/Oncology, The Children Hospital and ICH, Ferozepur Road, Lahore, Pakistan.
authors.forename: Alia
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Department of Paediatric Oncology, Royal Marsden Hospital, Downs Road, Sutton, London, UK SM2 5PT.
authors.forename: Donna
authors.initials: D
authors.lastname: Lancaster
authors.affiliation: Department of Paediatric Oncology, Royal Marsden Hospital, Downs Road, Sutton, London, UK SM2 5PT.
authors.forename: Ayad
authors.initials: A
authors.lastname: Atra
authors.affiliation: Department of Paediatrics, Lahore General Hospital and PGMI, Lahore, Pakistan.
authors.forename: Agha Shabbir
authors.initials: AS
authors.lastname: Ali
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D010154:Pakistan / Q000453:epidemiology; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome