CLINICAL OUTCOME OF CHILDREN WITH HODGKIN LYMPHOMA AFTER - PowerPoint PPT Presentation

CLINICAL OUTCOME OF CHILDREN WITH HODGKIN LYMPHOMA AFTER CHEMOTHERAPY ALONE-THE RED CROSS CHILDREN’S HOSPITAL EXPERIENCE G E O R G E C H A G A L U K A H A E M ATO L O G Y A N D O N C O L O G Y S E RV I C E , D E PA RT M E N T O F PA E D I AT R I C S A N D C H I L D H E A LT H , R E D C R O S S C H I L D R E N S H O S P I TA L , U N I V E R S I T Y O F C A P E TO W N .

INTRODUCTION  Majority of children and adolescents with classical HL are likely to be cured.  Current strategies are directed at limiting adverse effects.  Hybrid regimes have been developed .  Lower cumulative doses of alkylators, doxorubicin and bleomycin.  Red Cross Children’s Hospital adopted the UKCCSG ChlVbPP/ABVD protocol in 2005.  This study is a review since the protocol was adopted.

OBJECTIVE  To assess the efficacy of standardised hybrid chemotherapy for Hodgkin lymphoma

METHODOLOGY  Retrospective document review  Thirty five children with HL treated between 2005-2012  Patients received alternating ChlVbPP and ABVD  Stage 1: 2 courses of each  Stage 2-4: 3 courses of each  Relapsed or refractory patients were treated with EPIC +IFRT  Autologous stem cell transplantation was reserved for poor responders after 4 courses of EPIC

TREATMENT PROTOCOL ChlVbPP to alternate with ABVD every 28 days Chl Chlorambucil 6mg/m²/day PO on days 1-14 Vb Vinblastine 6 mg/m² (max 10mg) IV push on day 1 and 8 P Procarbazine 100mg/m²/day PO on days 1-14 P Prednisolone 40mg/m²/day PO on days 1-14 A Doxorubicin 25mg/m² on days 1 and 15 B Bleomycin 10,000units/m² IV push on days 1 and 15 V Vincristine 1.5mg/m² IV push on days 1 and 15 D Dacarbazine 375mg/m² IV push on days 1 and 15

RESULTS Patient characteristics 1. Variable Number Percentage Age (years) < 6 7 20 6-12 17 48.6 12- 18 11 31.4 Sex Male 25 71.4 Female 10 28.6 HIV Infected 2 5.7 Uninfected 33 94.3 Stage 1 7 20 2 10 28.6 3 7 20 4 11 31.4

2. Disease characteristics Variable Number Percentage Primary site Cervical 25 71.4 Mediastinal 6 17.1 Supraclavicular 4 11.4 Presence of B symptoms Yes 18 51.4 No 17 48.6 Histology Nodular sclerosing 22 62.9 Mixed cellularity 9 25.7 Lymphocyte predominant 3 8.6 Lymphocyte depleted 1 2.9 Bulky disease Yes 14 40 NO 21 60 Bone marrow involvement Yes 7 20 No 28 80

3. Current Status 8  Thirty (85.7%) patients are still alive including 2 lost to follow up in remission.  Six (17%) patients relapsed  2 Stage 3 patients - both salvaged  4 Stage 4 patients – only 1 could be salvaged  Three of the six relapses (50%) were salvaged  Four (11.4%) patients died  3 relapsed Stage 4 and 1 refractory Stage 4 patients

4. Overall survival (OS)

5. Event Free Survival (EFS)

DISCUSSION 11  Good overall survival (OS) for stage 1, 2 and 3.  Good event free survival (EFS) for stage 1 and 2.  Patients who relapsed were likely to have:  Stage 4 disease (p=0.008)  B symptoms (p=0.011)  Bone marrow involvement (p=0.006).  All the patients who died and all but one of the relapses had Nodular sclerosing histology.  Treatment was well tolerated with few acute toxicities.

CONCLUSION 12  Single treatment modality using chemotherapy alone is effective for Stage 1, 2 and 3 disease .  Stage 4 disease requires earlier evaluation to detect poor responders or patients with refractory disease, with a view to changing protocol.

ACKNOWLEDGEMENTS 13  Prof A. Davidson  Dr M. Hendricks  Dr A. Van Eyssen  Children with cancer  Nurses and Doctors at Red Cross  Parents and guardians