Clinical Presentation and Outcome of Hodgkin's Lymphoma in Children: A Retrospective Study

Background Hodgkin’s Lymphoma (HL) is one of the most curable malignancies of childhood, with chemotherapy alone or in combination with radiotherapy (RT) being the preferred treatment modality, albeit associated with significant acute and late toxicities. Therefore, this retrospective study aims to comprehend clinical-biological differences from the west, analyse local prognostic factors, and evaluate outcomes and toxicity with current therapy. Methods This retrospective study included 355 treatment-naive patients with classical HL. All patients received 4–8 cycles of upfront ABVD-based chemotherapy followed by involved field radiotherapy (IFRT) to the bulky/residual sites. Relapsed patients received one of the commonly used salvage regimens (GDP, ICE, or MINE). Analyses were conducted for interim response assessment and end-of-treatment response. Results Out of the 355 patients evaluated, 167 presented with advanced-HL (Stage IIBX, III & IV), and 15 of these 167 were ineligible for the final analysis due to various reasons. The median age was 9.7 years, and the male-to-female ratio was 5.9:1. The primary histologic subtype was mixed cellularity. The majority (73%) had stage III disease, with 80 out of 152 (53%) presenting 'B' symptoms and 69 out of 152 (45%) having bulky disease. Extranodal involvement was observed in 26% of patients. The first-line treatment regimen was ABVD for all patients, with IFRT in 68 (44.7%) cases. At the end of therapy, 83% of patients achieved complete remission (CR), while 32 (21%) progressed or relapsed. The median follow-up was 37 months, and the overall survival (OS) and event-free survival (EFS) rates were 83.6% and 78% at three years, respectively. These survival rates were lower than those reported in studies from the west. The CHIPS score was a prognostic factor that evaluated four of the mentioned factors (Stage IV, bulky mediastinal disease, serum albumin, and fever). The event-free survival rate was 83% for patients with a CHIPS score of 0 or 1, 70% for those with a CHIPS score of 2, and 61% for those with a CHIPS score of 3 or 4. Conclusion The CHIPS score can predict the outcome of children with advanced HL treated with ABVD-based therapy but requires prospective validation.