Comparison of Hodgkin’s Lymphoma in Children and Adolescents. A Twenty Year Experience with MH’96 and LH2004 AIEOP (Italian Association of Pediatric Hematology and Oncology) Protocols

Abstract

Adolescents and young adults (AYAs) represent a distinct group of patients. The objectives of this study were: To compare adolescent prognosis to that of younger children; to compare the results achieved with the two consecutive protocols in both age groups; to analyze clinical characteristics of children and adolescents. Between 1996 and 2017, 1759 patients aged <18 years were evaluable for the study. Five hundred and sixty patients were treated with the MH’96 protocol and 1199 with the LH2004 protocol. Four hundred and eighty-two were adolescents aged ≥15 years. Patients in both age groups showed very favorable prognoses. In particular, OS improved with the LH2004 protocol, especially in the adolescent group and in the low risk group, where radiation therapy was spared. Adolescent characteristics differed significantly from the children’s according to sex, histology, and the presence of symptoms. Remarkable is the decrease both in mixed cellularity in the children and in low stages in both age groups in the LH2004 protocol with respect to MH’96 protocol. Based on our experience, adopting pediatric protocols for AYA does not compromise patient outcomes.

A Score for Predicting Freedom from Progression of Children and Adolescents with Hodgkin Lymphoma

“…RT was administered to the nodal regions involved, delivering from 14.4 Gy in patients who obtained a CR and 25.2 Gy in those obtaining a PR at the end of chemotherapy. Patients classified as low risk (TG1) and with a CR at the end of their chemotherapy omitted RT [1,3]. Although the outcomes were excellent, with a >10-year freedom-from-progression (FFP) rate of 72.18% and overall survival (OS) of 89.47% in our series, some patients' diseases progressed or relapsed.…”

“…We analyzed 133 patients with HL aged 13 ± SEM 0.32 (range 3 to 18) years, treated according to the AIEOP LH-2004 between 2004 and 2017 [1] The inclusion criteria required biological samples for genetic analysis of HLA-G SNP, a set of hematological and biochemical parameters (i.e., erythrocyte sedimentation rate, albumin, ferritin, hemoglobin, white blood cell (WBC) count, neutrophils, eosinophils, basophils, lymphocytes, monocytes, and platelets); TG groups; World Health Organization (WHO) histological classification of HL (i.e., HD of unclassifiable subtype; MC, mixed cellularity; LRCHL, lymphocyte-rich cHL; NS, nodular sclerosis); sex; and age. Compared with our previous report on HLA-G SNP [4], the present study concerns a median followup about three years longer (median 5.55 years (interquartile range (IQR) 4.09-7.93)), 66 new cases, and hematological and biochemical parameters.…”

“…In addition to TG and HLA-G SNP covariates previously found to be associated with a better FFP survival in cHL patients [1,4], we added the variable neutrophils to the multivariate Cox proportional-hazard regression model via the backward procedure. Thus, to perform the multivariate analysis, we included TG (group number), HLA-G SNP (C/A), and neutrophils (8 × 10 9 /L) conditions.…”

“…In the AIEOP LH-2004 protocol's de-escalation of chemoradiotherapy for pediatric and adolescent Hodgkin lymphoma (cHL), risk stratification for patients at higher risk of disease progression or relapse became fundamental to identify candidates for less intensive treatment. Using the current standard of care for pediatric/adolescent cHL, patients allocated to three treatment groups (TG) with both the number of cycles and the addition of radiotherapy depending on the stage, and the computed tomography and positron emission tomography (PET)-guided response assessments [1,2]. TG1 included stage IA or IIA without bulky mediastinal disease or pulmonary hilar lymph node involvement and less than four positive lymph node regions.…”

Brentuximab vedotin in combination with bendamustine in pediatric patients or young adults with relapsed or refractory Hodgkin lymphoma

“…It has a bimodal age distribution of incidence (ages 15–40 and after age 55) accounting 29.7 cases per 1 million per year in Europe among adolescents and young adults; the highest incidence being recorded in Italy (64.6 cases per 1 million per year) 3 . Standard front‐line treatment with dose‐intensified chemotherapy in combination with radiotherapy has led to a 5‐year overall survival (OS) rate that exceeds 90% for all risk groups of children/adolescents with HL 4,5 . Radiotherapy continues to be used for some subgroups of pediatric patients, although it is no longer considered standard of care for all low‐ and intermediate‐risk patients in the adult setting 6 .…”