title: Treatment outcomes of children with Hodgkin lymphoma between 2000 and 2010: First report by the South African Children's Cancer Study Group.
abstract: BACKGROUND
  Children with Hodgkin lymphoma (HL) have excellent survival rates in high-income countries, but there are minimal outcome data in South African patients. Differing approaches to treatment are used in centres across South Africa, and the South African Children's Cancer Study Group (SACCSG) embarked on a programme to audit outcomes to improve survival rates.
  
  
  METHODS
  A multicentre study was conducted to analyse outcomes and prognostic factors of children with HL in South Africa. Ten dedicated South African paediatric oncology units participated in a retrospective data review. All patients with HL treated consecutively between January 2000 and December 2010 were included. Kaplan-Meier curves and Cox regression model were employed to determine survival rates and prognostic factors.
  
  
  RESULTS
  Two hundred and ninety-four patients were eligible for inclusion. The median age at presentation was 9.6 years (range 2.9-18.8); 55.4% of the patients presented with Stage III and IV disease and 9.9% were human immunodeficiency virus (HIV) positive. First-line therapy consisted of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) in 158 patients, vincristine, procarbazine/etoposide, prednisone and doxorubicin in 97 and adriamycin, bleomycin, vincristine and dacarbazine-chlorambucil, vinblastine, prednisone and procarbazine in 23 patients. The 5-year overall survival (OS) was 79% (95% confidence interval 73-84%). Multivariate analysis demonstrated that HIV infection (P = 0.018) and Ann Arbor Stage III and IV disease (P = 0.006) conferred a poor prognosis, while treatment with ABVD was associated with higher survival rates (P = 0.028).
  
  
  CONCLUSIONS
  OS rates are encouraging for a middle-income country, although economic disparities continue to impact negatively on outcomes. Study results will form the basis for the development of national protocol and continued advocacy to rectify disparities.
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Geel
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Tobias C
authors.initials: TC
authors.lastname: Chirwa
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
authors.forename: Biance
authors.initials: B
authors.lastname: Rowe
authors.affiliation: Faculty of Economics, University of Cape Town, Cape Town, South Africa.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Eyal
authors.affiliation: Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.
authors.forename: Fareed
authors.initials: F
authors.lastname: Omar
authors.affiliation: Faculty of Health Sciences, University of the Free State, Universitas Hospital, Bloemfontein, South Africa.
authors.forename: David K
authors.initials: DK
authors.lastname: Stones
authors.affiliation: Faculty of Health Sciences, University of Kwazulu-Natal, Inkosi Albert Luthuli Hospital, Durban, South Africa.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Goga
authors.affiliation: South African Medical Research Council, Parow, South Africa.
authors.forename: D Cristina
authors.initials: DC
authors.lastname: Stefan
authors.affiliation: Faculty of Health Sciences, University of Stellenbosch, Tygerberg Hospital, Tygerberg, South Africa.
authors.forename: Anel
authors.initials: A
authors.lastname: van Zyl
authors.affiliation: Divison of Paediatric Haemetology and Oncology, Frere Hospital, East London, South Africa.
authors.forename: Barry
authors.initials: B
authors.lastname: Van Emmenes
authors.affiliation: Divison of Paediatric Haemetology and Oncology, Polokwane-Mankweng Hospital Complex, Polokwane, South Africa.
authors.forename: Oloko
authors.initials: O
authors.lastname: Wedi
authors.affiliation: Netcare Parklands Hospital, Durban, South Africa.
authors.forename: Manickavallie
authors.initials: M
authors.lastname: Vaithilingum
authors.affiliation: Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Hendricks
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003606:Dacarbazine / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin
keywords: Hodgkin disease; SACCSG; South Africa; prognostic indicators