Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa

Jennifer Geel¹, Anel van Zyl², Jan du Plessis³, Marc Hendricks⁴, Yasmin Goga⁴, Amy Carr⁵, Beverley Neethling⁶, Artsiom Hramyka⁷, Fareed Omar⁸, Rema Mathew⁹, Lizette Louw¹⁰, Thanushree Naidoo^{11

12}, Thandeka Ngcana¹³, Tanya Schickerling¹⁴, Vutshilo Netshituni¹⁵, Elelwani Madzhia¹⁶, Liezl du Plessis¹⁷, Tom Kelsey⁷, Daynia E Ballot¹⁸, Monika L Metzger¹⁹

Affiliations

¹ Pediatric Haematology-Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
² Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
³ Pediatric Haematology-Oncology, University of the Free State, Universitas Hospital, Bloemfontein, South Africa.
⁴ Department of Paediatrics and Child Health, Haematology-Oncology Service, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
⁵ Pediatric Haematology-Oncology, University of KwaZulu-Natal Durban, Greys Hospital, Pietermaritzburg, South Africa.
⁶ Pediatric Haematology-Oncology, University of KwaZulu-Natal Durban, Inkosi Albert Luthuli Hospital and Greys Hospital, Pietermaritzburg, South Africa.
⁷ School of Computer Science, University of St Andrews, St Andrews, UK.
⁸ Pediatric Haematology-Oncology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.
⁹ Pediatric Haematology-Oncology, Walter Sisulu University, Frere Hospital, East London, South Africa.
¹⁰ Centre of Molecular Imaging and Theranostics, Johannesburg, South Africa.
¹¹ Department of Radiation Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
¹² Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
¹³ Pediatric Haematology-Oncology, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
¹⁴ Netcare Alberton Hospital, Johannesburg, South Africa.
¹⁵ Pediatric Haematology-Oncology, University of Limpopo, Polokwane-Mankweng Hospital Complex, Polokwane, South Africa.
¹⁶ Pediatric Haematology-Oncology, Sefako Makgatho University, Dr George Mukhari Hospital, Garankuwa, South Africa.
¹⁷ Pediatric Haematology-Oncology, University of the Free State, Kimberley Hospital, Kimberley, South Africa.
¹⁸ School of Clinical Medicine, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
¹⁹ Medecins sans Frontieres, Geneva, Switzerland.

PMID: 37814417
DOI: 10.1002/pbc.30712

Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa

Jennifer Geel et al. Pediatr Blood Cancer. 2024 Jan.

. 2024 Jan;71(1):e30712.

doi: 10.1002/pbc.30712. Epub 2023 Oct 9.

Authors

Affiliations

¹ Pediatric Haematology-Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
² Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
³ Pediatric Haematology-Oncology, University of the Free State, Universitas Hospital, Bloemfontein, South Africa.
⁴ Department of Paediatrics and Child Health, Haematology-Oncology Service, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
⁵ Pediatric Haematology-Oncology, University of KwaZulu-Natal Durban, Greys Hospital, Pietermaritzburg, South Africa.
⁶ Pediatric Haematology-Oncology, University of KwaZulu-Natal Durban, Inkosi Albert Luthuli Hospital and Greys Hospital, Pietermaritzburg, South Africa.
⁷ School of Computer Science, University of St Andrews, St Andrews, UK.
⁸ Pediatric Haematology-Oncology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.
⁹ Pediatric Haematology-Oncology, Walter Sisulu University, Frere Hospital, East London, South Africa.
¹⁰ Centre of Molecular Imaging and Theranostics, Johannesburg, South Africa.
¹¹ Department of Radiation Oncology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
¹² Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
¹³ Pediatric Haematology-Oncology, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
¹⁴ Netcare Alberton Hospital, Johannesburg, South Africa.
¹⁵ Pediatric Haematology-Oncology, University of Limpopo, Polokwane-Mankweng Hospital Complex, Polokwane, South Africa.
¹⁶ Pediatric Haematology-Oncology, Sefako Makgatho University, Dr George Mukhari Hospital, Garankuwa, South Africa.
¹⁷ Pediatric Haematology-Oncology, University of the Free State, Kimberley Hospital, Kimberley, South Africa.
¹⁸ School of Clinical Medicine, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
¹⁹ Medecins sans Frontieres, Geneva, Switzerland.

PMID: 37814417
DOI: 10.1002/pbc.30712

Abstract

Background: Historic South African 5-year overall survival (OS) rates for Hodgkin lymphoma (HL) from 2000 to 2010 were 46% and 84% for human immunodeficiency virus (HIV)-positive and HIV-negative children, respectively. We investigated whether a harmonised treatment protocol using risk stratification and response-adapted therapy could increase the OS of childhood and adolescent HL.

Methods: Seventeen units prospectively enrolled patients less than 18 years, newly diagnosed with classical HL onto a risk-stratified, response-adapted treatment protocol from July 2016 to December 2022. Low- and intermediate-risk patients received four and six courses of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), respectively. High-risk patients received two courses of ABVD, followed by four courses of cyclophosphamide, vincristine, prednisone, and dacarbazine (COPDac). Those with a slow early response and bulky disease received consolidation radiotherapy. HIV-positive patients could receive granulocyte colony-stimulating factor and less intensive therapy if stratified as high risk, at the treating clinician's discretion. Kaplan-Meier survival analysis was performed to determine 2-year OS and Cox regression to elucidate prognostic factors.

Results: The cohort comprised 132 patients (19 HIV-positive, 113 HIV-negative), median age of 9.7 years, with a median follow-up of 2.2 years. Risk grouping comprised nine (7%) low risk, 36 (27%) intermediate risk and 87 (66%) high risk, with 71 (54%) rapid early responders and 45 (34%) slow early responders, and 16 (12%) undocumented. Two-year OS was 100% for low-risk, 93% for intermediate-risk, and 91% for high-risk patients. OS for HIV-negative (93%) and HIV-positive (89%) patients were similar (p = .53). Absolute lymphocyte count greater than 0.6 × 10⁹ predicted survival (94% vs. 83%, p = .02).

Conclusion: In the first South African harmonised HL treatment protocol, risk stratification correlated with prognosis. Two-year OS of HIV-positive and HIV-negative patients improved since 2010, partially ascribed to standardised treatment and increased supportive care. This improved survival strengthens the harmonisation movement and gives hope that South Africa will achieve the WHO Global Initiative for Childhood Cancer goals.

Keywords: GICC; Hodgkin lymphoma; South Africa; adolescent; child; harmonisation.

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References

REFERENCES

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1. Geel JA, Chirwa TC, Rowe B, et al. Treatment outcomes of children with Hodgkin lymphoma between 2000 and 2010: first report by the South African Children's Cancer Study Group. Pediatr Blood Cancer. 2017;64(10):e26536. doi:10.1002/pbc.26536

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Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa

Affiliations

Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical