Testi Anna Maria, Al-Jadiry Mazin Faisal, Moleti Maria Luisa, Uccini Stefania, Al-Darraij Amir Fadhil, Al-Saeed Raghad Majid, Ghali Hasanein Habeeb, Sabhan Ahmed Hatem, Fadhil Samaher Abdulrazzaq, Al-Badri Safaa Abdulelah, Alsaadawi Adil Rabeea, Hameedi Ameer Dh, Shanshal Manhal Hashim, Al-Agele Yasir Saadoon, Al-Saffar Fatimah Abdul Ridha, Yaseen Nihal Khalid, Piciocchi Alfonso, Marsili Giovanni, Al-Hadad Salma Abbas
Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
College of Medicine-University of Baghdad, Children Welfare Teaching Hospital-Medical City, Pediatrics, Baghdad, Iraq.
Mediterr J Hematol Infect Dis. 2024 Jul 1;16(1):e2024053. doi: 10.4084/MJHID.2024.053. eCollection 2024.
Childhood Hodgkin lymphoma (HL) is an eminently curable disease. Good outcomes can be achieved even in resource-limited settings, and the focus is increasingly on limiting long-term toxicity. Contemporary treatment incorporates a risk-stratified, response-adapted approach using multiagent chemotherapy with/without low-dose radiotherapy. Many developing countries continue to use ABVD-based regimens due to limited acute toxicity, cost, and ease of delivery.
We herein report the outcomes of childhood HL diagnosed and treated in an Iraqi single centre over 16 years.
Children ≤14 years old with biopsy-proven HL were enrolled. Most patients received ABVD chemotherapy or COPP/ABV when Dacarbazine was unavailable. Radiotherapy was not available.
Three hundred-three children were consecutively newly diagnosed with HL; 284 were considered eligible for the retrospective analysis (treatment refusals 9; deaths before therapy 5; initially diagnosed of non-Hodgkin lymphoma 5). ABVD scheme was administered to 184 children (65%), COPP/ABV to 83 (29%), and other schemes to the remaining 17 patients. Complete response (CR) was achieved in 277 (98%); 4 (1.4%) showed disease progression, and 1 had stable disease. Four patients in CR abandoned therapy and were in CR at the time of analysis, 2 died from infection. Relapse occurred in 42 patients (15%). The 15-year OS and EFS are 89.7% and 70.3%, respectively.
In this single Centre, over 16 years, almost 90% of children suffering from HL survive, despite the numerous limitations in diagnostic procedures, shortage of chemotherapy, no radiotherapy facilities, absence of effective second-line treatments, and finally, therapy abandonment for social and financial reasons.
儿童霍奇金淋巴瘤（HL）是一种治愈率很高的疾病。即使在资源有限的环境中也能取得良好的治疗效果，并且重点越来越多地放在限制长期毒性上。当代治疗采用风险分层、根据反应调整的方法，使用多药化疗并结合或不结合低剂量放疗。由于急性毒性有限、成本低且易于实施，许多发展中国家继续使用基于阿霉素、博来霉素、长春新碱和达卡巴嗪（ABVD）的方案。
我们在此报告伊拉克一个单一中心16年来诊断和治疗的儿童HL的治疗结果。
纳入年龄≤14岁、经活检证实为HL的儿童。大多数患者接受ABVD化疗，当无法获得达卡巴嗪时接受环磷酰胺、长春新碱、丙卡巴肼和强的松/阿霉素、博来霉素、长春新碱（COPP/ABV）化疗。无法进行放疗。
303名儿童被连续新诊断为HL；284名被认为符合回顾性分析条件（9名拒绝治疗；5名在治疗前死亡；5名最初被诊断为非霍奇金淋巴瘤）。184名儿童（65%）接受ABVD方案，83名（29%）接受COPP/ABV方案，其余17名患者接受其他方案。277名（98%）实现完全缓解（CR）；4名（1.4%）疾病进展，1名病情稳定。4名CR患者放弃治疗，在分析时处于CR状态，2名死于感染。42名患者（15%）复发。15年总生存率（OS）和无事件生存率（EFS）分别为89.7%和70.3%。
在这个单一中心的16年里，尽管诊断程序存在诸多限制、化疗短缺、没有放疗设施、缺乏有效的二线治疗，最后还有因社会和经济原因放弃治疗的情况，但几乎90%的HL患儿存活了下来。
