Riaz Quratulain, Gul Rabel, Junaid Vashma, Farooq Wasfa, Khayyam Naema
Department of Paediatric Oncology, Indus Hospital & Health Network, Karachi, Sindh 75190, Pakistan.
https://orcid.org/0009-0002-3161-7508.
Ecancermedicalscience. 2024 Jul 16;18:1729. doi: 10.3332/ecancer.2024.1729. eCollection 2024.
With conventional standard treatment modalities, children and adolescents with Hodgkin lymphoma (HL) have long-term overall survival rates of over 90%. However, primary refractory disease may occur in 5%-10% of HL patients, while relapse occurs in 5%-10% of patients with early stage disease and up to 30% in an advanced stage. This retrospective study evaluated patient characteristics in cases of HL relapse and refractory and their response to second-line treatment of standalone chemotherapy or in combination with radiotherapy.
A retrospective study was conducted by Indus Hospital and Health Network to determine the outcomes of paediatric patients with first and second relapses of HL between 2013 and 2022.
A total of 742 patients were diagnosed with HL at Indus Hospital & Health Network. Of these, 48 (6.5%) patients presented with relapse and 35 (4.7%) with refractory disease after initial chemotherapy. In HL relapse patients, 57% were stage IV at initial diagnosis with the most common pathology being nodular sclerosis constituting 42.9% of patients. The most common age group was 6-10 years, 45.8%. B symptoms were experienced by 25 (52%) patients. A time to relapse of >12 months following diagnosis was seen in 69% and 3-12 months was seen in 31%.After receiving second-line treatment, complete remission was achieved by 34 (70.8%) patients, partial remission (PR) was seen in 5 (10.4%), disease progression in 5 (10.4%), 3 (6.3%) patients left during treatment and 1 (2.1%) had a treatment-related mortality. Re-radiation in second-line treatment was only required for 2 patients. The second relapse was seen in 11 (28.2%) of 39 complete and PR patients.
Major limitations in the treatment of HL relapse in a low-resource setting are the non-availability of immunotherapy and autologous stem cell transplantation due to extreme financial burden and lack of capacity in facilities. Dedicated efforts are required to provide these facilities free of cost in low-middle income countries (LMICs).
采用传统标准治疗方式，霍奇金淋巴瘤（HL）患儿和青少年的长期总生存率超过90%。然而，5%-10%的HL患者可能会出现原发性难治性疾病，早期疾病患者中有5%-10%会复发，晚期患者的复发率高达30%。这项回顾性研究评估了HL复发和难治病例的患者特征及其对单独化疗或联合放疗的二线治疗的反应。
印度河医院与健康网络开展了一项回顾性研究，以确定2013年至2022年间HL首次和第二次复发的儿科患者的治疗结果。
印度河医院与健康网络共诊断出742例HL患者。其中，48例（6.5%）患者出现复发，35例（4.7%）患者在初始化疗后出现难治性疾病。在HL复发患者中，57%在初始诊断时为IV期，最常见的病理类型是结节硬化型，占患者的42.9%。最常见的年龄组是6-10岁，占45.8%。25例（52%）患者有B症状。69%的患者在诊断后>12个月复发，31%的患者在3-12个月复发。接受二线治疗后，34例（70.8%）患者实现完全缓解，5例（10.4%）患者部分缓解（PR），5例（10.4%）疾病进展，3例（6.3%）患者在治疗期间离开，1例（2.1%）有治疗相关死亡。二线治疗中仅2例患者需要再次放疗。39例完全缓解和PR患者中有11例（28.2%）出现第二次复发。
在资源匮乏地区，HL复发治疗的主要限制是由于经济负担过重和设施能力不足，无法获得免疫疗法和自体干细胞移植。在低收入和中等收入国家（LMICs），需要做出专门努力免费提供这些设施。
