Impact of using combined chemotherapy regimen in children with Hodgkin lymphoma in countries with limited resources: a single center experience in Iraq

Objective/Background: Data about Hodgkin lymphoma (HL) in developing countries are scattered. The aim of this study is to present clinical features and outcome of children with HL using combined different chemotherapy regimens. Response-based approach was applied irrespective of risk stratification.Methods: Patients aged 18 years and younger who were diagnosed with HL between January 2014 and December 2021 in a cancer center in Iraq, were recruited. Patients were stratified into three risk groups. Initial treatment with induction chemotherapy (i.e., 2 cycles of ABVD) was applied to all patients. Patients who achieved complete radiological response to induction chemotherapy continued with 4-6 cycles of ABVD; radiotherapy was omitted. Patients with slow early response received 3 cycles of COPDac after 3rd cycle of ABVD, followed by radiotherapy.Results: fifty-nine patients were enrolled in this study. The median age was 7 years. Twenty (33.9%) patients were stage III, followed by stage II (32.2%). Twenty-five patients had B symptoms. Initial splenic involvement was found in 11 patients. Approximately one third of patients had bulky disease (n = 19; 32.2%). The most common histology was mixed cellularity (n = 44). The median follow-up was 2.7 year (range from 0.1 to 7.5 years). The 5-year estimates of survival and EFS were 92% and 78% +/- 10%, respectively. Only bulky disease had a significant negative influence on the outcome.Conclusion: Good outcomes for pediatric HL patients can be achieved in low and middle income countries. Response-based therapy approach is feasible to reduce long term treatment-related sequel.