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

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Sep 28, 2022 15 likes •145 views

CLINICAL OUTCOME OF CHILDREN WITH HODGKIN LYMPHOMA AFTER CHEMOTHERAPY ALONE-THE RED CROSS CHILDRENS 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

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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 .

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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.

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OBJECTIVE

To assess the efficacy of standardised hybrid

chemotherapy for Hodgkin lymphoma

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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

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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

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RESULTS

1.

Patient characteristics

Variable Number Percentage

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

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2. Disease characteristics

Variable Number Percentage

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

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3. Current Status
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

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4. Overall survival (OS)

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5. Event Free Survival (EFS)

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DISCUSSION

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.

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CONCLUSION

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.

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ACKNOWLEDGEMENTS

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