Combined therapy in children and adolescents with classical Hodgkin's lymphoma: A report from the SFCE on MDH-03 national guidelines

Seror, E.; Donadieu, Jean; Pacquement, Hélène; Abbou, Samuel; Lambilliotte, Anne; Schell, Matthias; Curtillet, Catherine; Gandemer, Virginie; Pasquet, Marlène; Aladjidi, Nathalie; Lutz, Patrick; Schmitt, Claudine; Deville, Anne; Minckes, Odile; Vanier, J; Armari‐Alla, Corinne; Thomas, Caroline; Gorde-Grosjean, Stéphanie; Millot, Frédéric; Blouin, P.; Garnier, Nathalie; Coze, Carole; Devoldère, Catherine; Réguerre, Yves; Helfre, Sylvie; Claude, L.; Clavel, Jacqueline; Oberlin, Odile; Landman‐Parker, Judith; Leblanc, Thierry

doi:10.1080/08880018.2016.1247393

Cited by 6 publications

(7 citation statements)

References 30 publications

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“…In high-income countries, the overall survival rate of HL treatment with combined chemo-and radiotherapy is greater than 90%. [34][35][36] The aim of current protocols for the treatment of HL is to substitute alkylating agents and reduce the RESEARCH use of radiotherapy for early stages of disease, which respond well to initial chemotherapy. [37] The current European protocols indicate radiotherapy for the territories initially affected according to the therapeutic response.…”

Section: Discussionmentioning

confidence: 99%

Treatment of childhood Hodgkin lymphoma in sub-Saharan Africa: A report from the French-African Paediatric Oncology Group (GFAOP)

Akondé

Togo²,

Moreira

et al. 2020

S Afr J CH

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This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Hodgkin lymphoma (HL) is a B-cell line lymphoma, characterised histologically by the presence of large, atypical cells called Reed-Sternberg cells. The first histological description dates back to 1832 by Thomas Hodgkin. [1] Epstein-Barr virus (EBV) is an important factor in the pathogenesis of HL and it is detected in Reed-Sternberg cells in the vast majority of HL specimens from developing countries, but much less frequently in high-income countries. [2] The incidence of HL is 1.2 per 100 000 children and represents the most common malignant tumour in adolescents in high-income countries, and the majority of cases are diagnosed at an early stage of disease. [3] Hodgkin's disease is more common in children under 10 years of age in developing countries. HL is a malignant but highly curable tumour and its treatment is one of the success stories of modern medicine. The use of chemotherapy combined with radiotherapy has greatly improved the survival rate of advanced stages of the disease. In high-income countries, the event-free survival and overall survival rates are 85% and 90%, respectively. [4,5] The reported results of therapy of HL in low-and middle-income countries (LMICs) are not as good, due to several factors. [6,7] One of the key reasons is that radiation therapy centres in sub-Saharan Africa are rare, but efforts are underway to address this issue. [8,9] Studies from one institution using chemotherapy alone in the treatment of HL have shown encouraging results. [10,11] This therapeutic strategy has been adopted by the French-African Paediatric Oncology Group (GFAOP) to improve the treatment of children with HL in sub-Saharan Africa. In this article, we present the results of a prospective, collaborative, multicentre study on the management of HL using only chemotherapy in GFAOP institutions. Methods This was a prospective, multicentre study aimed at evaluating the feasibility of using only COPP/ABV hybrid chemotherapy (cyclophosphamide, vincristine, procarbazine, prednisone, adriamycin, bleomycin and vinblastine) in treating children diagnosed Background. Childhood Hodgkin lymphoma (HL) is typically treated by chemo-and radiotherapy, depending on the stage of the disease. Studies on the treatment of HL by chemotherapy alone have shown encouraging results. Objective. To evaluate the feasibility, epidemiological and therapeutic aspects of paediatric HL treated with only COPP/ABV hybrid chemotherapy (cyclophosphamide, vincristine, procarbazine, prednisone, adriamycin, bleomycin and vinblastine). Methods. This was a prospective multicentre study on the management of HL in paediatric oncology centres of the French-African Paediatric Oncology Group in sub-Saharan Africa, from 1 October 2006 to 30 November 2012. To be included in the study, patients had to be younger than 18 years at diagnosis, with histologically proven HL. Results. A total of 106 patients were included, with a median age of 10 years (range: 2-18 years). The s...

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Section: Discussionmentioning

confidence: 99%

Treatment of childhood Hodgkin lymphoma in sub-Saharan Africa: A report from the French-African Paediatric Oncology Group (GFAOP)

Akondé

Togo²,

Moreira

et al. 2020

S Afr J CH

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“…All patients were children under 18 years of age at the time of cHL diagnosis, and had sufficient pathological material from the initial diagnosis for analysis. The patients were treated according to one of three nationally used protocols—MDH 90, MDH 03, or EuroNet‐PHL‐C1, and a minimum 3‐year medical follow‐up period was required. The patients were divided into two groups; the first group included those who were cured (no relapse for at least 5 years) or who were in complete remission at the last follow‐up assessment, and the second included patients with relapsed or refractory cHL.…”

Section: Methodsmentioning

confidence: 99%

“…Classical Hodgkin lymphoma (cHL) accounts for 15% of childhood cancers (0‐18 years), with approximately 110 new cases diagnosed per year in France; children account for 5‐10% of all cases . In our experience, overall survival of 5 years can be achieved in more than 90% of patients under 18 years of age due to improvements in therapeutic strategies, which include chemotherapy stratified according to clinical stage, the de‐escalation of drugs causing sequelae, and external radiotherapy . However, the prognoses for refractory and relapsed cases remain poor despite intensive therapy with bone marrow auto‐ or allografts …”

Section: Introductionmentioning

confidence: 99%

“…1 In our experience, overall survival of 5 years can be achieved in more than 90% of patients under 18 years of age due to improvements in therapeutic strategies, which include chemotherapy stratified according to clinical stage, the de-escalation of drugs causing sequelae, and external radiotherapy. 2,3 However, the prognoses for refractory and relapsed cases remain poor despite intensive therapy with bone marrow auto-or allografts. 4 Abbreviations: cHL, classical Hodgkin lymphoma; EBV, Epstein-Barr virus These data are partly comparable in Hodgkin lymphoma (HL) of the adult.…”

Section: Introductionmentioning

confidence: 99%

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Expression of PD‐1/PD‐L1 in children's classical Hodgkin lymphomas

Dilly‐Feldis¹,

Aladjidi²,

Refait

et al. 2019

Pediatric Blood & Cancer

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Background Although a prognosis of recurrent or refractory childhood Hodgkin lymphoma (HL) is associated with poor outcomes despite intensive therapy, the immune checkpoint inhibitors PD‐1/PD‐L1 appear to be therapeutic alternatives for advanced adult cases. However, these pharmacotherapies are yet to be studied in a pediatric population. Procedure The present study measured the expression of PD‐1/PD‐L1 in diagnostic samples of children with classical HL, according to the disease course. This study included two groups of patients treated at the Department of Pediatric Oncology, Bordeaux University Hospital—a group of cured or in‐remission cases and a group of relapsed or refractory cases. Immunohistochemical analyses of anti‐PD‐1 and anti‐PD‐L1 (clone 28‐8, companion test for nivolumab) were performed on baseline and follow‐up biopsies. Results Of the 42 included patients, 31 were cured or in remission and 11 were categorized as relapsed or refractory. At the time of diagnosis, PD‐1 expression was low (1‐3% of intratumoral lymphocytes labeled) in <20% of cases, whereas PD‐L1 was expressed by tumor cells in all cases, and strongly (≥50%) in most cases. There were no significant differences in the expression levels of the two checkpoint molecules between the groups. Initial biopsies showed strong expression of PD‐L1, whereas expression of PD‐1 was rare. Conclusions The identical labeling profiles of the cured and relapsed/refractory patients suggest that comparable responses to inhibitors of the PD1/PDL1 immunological checkpoints could be expected in patients undergoing first‐, second‐, or third‐line therapy.

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“…Although it is possible that the substitution contributed to the poorer results, other pediatric treatment regimens [22][23][24][25] essential to guarantee good outcomes. These described failures pose a significant weakness of the guideline study, where the regimen was changed, not followed as written; and quality assurance interventions…”

Section: Discussionmentioning

confidence: 99%

Treatment of high‐risk Hodgkin lymphoma with a modified Stanford V regimen in the AHOPCA: Substituting chemotherapy agents and hampered outcomes

Luna‐Fineman,

Castellanos,

Metzger

et al. 2023

Pediatric Blood & Cancer

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Background/objectivesHigh‐risk Hodgkin lymphoma (HRHL) in children is curable with combined modality therapy. The Association of Pediatric Hematology‐Oncology of Central America (AHOPCA) is a consortium of cancer centers from Central America. In 2004, AHOPCA implemented a guideline with a short course of chemotherapy (mStanfordV), strict diagnostics, and radiation guidelines, aimed at reducing abandonment and improving outcomes.MethodsNewly diagnosed children less than 18 years of age with high‐risk HL (Ann Arbor stages: IIB, IIIB, IV) from AHOPCA centers were staged with chest radiography and ultrasound or computed tomography. Therapy was a modified Stanford V (mStanfordV), substituting cyclophosphamide for mechlorethamine and involved field radiation.ResultsOf 219 patients with HRHL, 181 patients were eligible and evaluable; 146 (81%) were boys, 22% being less than 6 years; 43 were stage IIB, 84 IIIB, and 54 IV. Thirty‐one (17%) abandoned therapy, 28 (15%) progressed, 30 (17%) relapsed, and eight (4%) died of toxicity. Radiation guidelines were not followed. Five‐year abandonment‐sensitive event‐free survival and overall survival (AS‐EFS, AS‐OS ± SE) for the cohort were 46% ± 4% and 56% ± 4%; 5‐year AS‐OS for stages IIB, IIIB, and IV was 76% ± 7%, 59% ± 7%, and 35% ± 7% (p = .0006).ConclusionDespite instituting a short treatment guideline, it did not improve the abandonment rate (17%) and did not achieve the reported outcomes of Stanford V. The cyclophosphamide dose used to replace merchlorethamine was inadequate. Despite strict guidelines, the radiation therapy application was inaccurate. Weekly chemotherapy may have adversely affected abandonment of therapy by increasing the burden of travel time. Based on these results, AHOPCA established a new abandonment strategy and a new guideline.

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Combined therapy in children and adolescents with classical Hodgkin's lymphoma: A report from the SFCE on MDH-03 national guidelines

Cited by 6 publications

References 30 publications

Treatment of childhood Hodgkin lymphoma in sub-Saharan Africa: A report from the French-African Paediatric Oncology Group (GFAOP)

Treatment of childhood Hodgkin lymphoma in sub-Saharan Africa: A report from the French-African Paediatric Oncology Group (GFAOP)

Expression of PD‐1/PD‐L1 in children's classical Hodgkin lymphomas

Treatment of high‐risk Hodgkin lymphoma with a modified Stanford V regimen in the AHOPCA: Substituting chemotherapy agents and hampered outcomes

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