Management of Hodgkins Lymphoma: ICMR Consensus Document

Radhakrishnan, Venkatraman; Kapoor, Gauri; Arora, Brijesh; Bansal, Deepak; Vora, Tushar; Prasad, Maya; Chinnaswamy, Girish; Laskar, Siddharth; Agarwala, Sandeep; Kaur, Tanvir; Rath, Goura Kishore; Bakhshi, Sameer

doi:10.1007/s12098-017-2304-6

Cited by 8 publications

(3 citation statements)

References 31 publications

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“…Usually, t h i s i s f o l l owe d by a d d i t i o n a l , p o s s i bly d i s t i n c t , chemotherapy. Radiation therapy, sometimes referred to as involved field radiation therapy, or IFRT, is usually applied to the tumor areas at this point, especially if the sickness was severe [6].…”

Section: Discussionmentioning

confidence: 99%

A Case Report on Stage Iv Hodgkin's Lymphoma

Dhivya

2024

PIJR

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Hodgkin's lymphoma (HL) is a type of cancer in young adults,characterized by a large inflammatory microenvironment and a low number of malignant cells originating from B lymphocytes. It is a distinct lymphomatous cancer that is histologically defined by Reed-Sternberg cells in the right kind of cell environment.The disease primarily affects young adults, with a peak incidence occurring between the ages of 15 and 35. There are two subtypes: classical Hodgkin lymphoma (CHL) and nodular lymphocyte predominant HL (NLPHL). A 75-year-old patient with Stage IV HL was admitted for chemotherapy cycle IA (75% dose) on 14/06/2023 and was prescribed medications such as Adriamycin, Vinblastine, and Dacarbazine. The patient had systemic hypertension, a cataract, and a hernia. The patient also had a history of loss of appetite, neck swelling, and difficulty in hearing.A biopsy from level III right neck showed Hodgkin's lymphoma (Lymphocyte rich CHL).The next cycle of chemotherapy was scheduled on 28/06/2023.The patient was also admitted for cycle IIA chemotherapy (75% dose) and was prescribed the same medications again.The next cycle was scheduled on 26/07/2023.

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Section: Discussionmentioning

confidence: 99%

A Case Report on Stage Iv Hodgkin's Lymphoma

Dhivya

2024

PIJR

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“…These recommendations are based on a detailed review of available Indian and international literature, and expert opinion has been used where adequate evidence was lacking. These guidelines cover the common pediatric tumors, including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), rhabdomyosarcoma, Wilms tumor, neuroblastoma, hepatoblastoma and germ cell tumor [1][2][3][4][5][6][7]. The prime focus of these guidelines includes diagnostic workup, and medical and surgical management of pediatric tumors.…”

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confidence: 99%

“…Few examples of such practices are use of fine needle aspiration cytology (FNAC) for diagnosis of lymphomas and frequent use of imaging in the follow-up of these patients. The guidelines on HL specifically discourage use of FNAC for diagnosis and also limit imaging studies in follow-up period [1]. This will sensitize local practitioners and small centers to move away from these practices.…”

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Editorial: Indian Guidelines for Treatment of Pediatric Malignancies

Tiwari

Bakhshi

2017

Indian J Pediatr

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Treatment strategies and protocols for pediatric tumors vary by health provider, treating center and geographical area within the country. The problem has been compounded by the rapid evolution in the world of oncology and advent of new technologies and treatment options. The cost of health care has also increased manifold in the recent times; further, all treatment options and modalities of diagnosis are not equally available in all places. This urges a need for a national guideline for management of pediatric tumors, which are made by experts in the field and with an Indian perspective in mind.These guidelines have been made with intent to bridge the gap between evidence and practice in the country, and make patient care more consistent. A multidisciplinary team of experts has contributed to the development of these guidelines. These recommendations are based on a detailed review of available Indian and international literature, and expert opinion has been used where adequate evidence was lacking. These guidelines cover the common pediatric tumors, including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), rhabdomyosarcoma, Wilms tumor, neuroblastoma, hepatoblastoma and germ cell tumor [1][2][3][4][5][6][7]. The prime focus of these guidelines includes diagnostic workup, and medical and surgical management of pediatric tumors. The guidelines are largely consistent with the pediatric oncology guidelines by other international bodies.The review is complete and includes the most-recent abstracts and articles. For example, the guidelines have accepted the results of the interim analysis of Inter-B-NHL Ritux 2010 trial and recommend the use of rituximab in high-risk B-NHL along with intensive chemotherapy protocol [8]; use of rituximab is also recommended in patients with relapsed B-NHL.The prime benefit of having an evidence-based guideline is that it helps patients from across the country to get standard, evidence-based uniform care. This will ensure that the quality of care is not compromised based on where and by whom the patient is being treated, and is likely to improve the outcomes of these patients and decrease the disease-related morbidity and mortality. The cost-effectiveness of management of these tumors is also likely to improve by eliminating unnecessary diagnostic evaluations and treatment that add to cost but are not based on evidence. Few examples of such practices are use of fine needle aspiration cytology (FNAC) for diagnosis of lymphomas and frequent use of imaging in the follow-up of these patients. The guidelines on HL specifically discourage use of FNAC for diagnosis and also limit imaging studies in follow-up period [1]. This will sensitize local practitioners and small centers to move away from these practices.These guidelines also address some of the ground realities of the country; for example, it stresses upon the fact that neoadjuvant chemotherapy followed by surgery is the preferred approach in children with Wilms tumors, keeping in mind the size of the tumors at presentation, and ...

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Clinical profile and outcome of classical Hodgkin lymphoma treated with a risk‐adapted approach in a tertiary cancer center in India

Parambil

Narula

Prasad

et al. 2019

Pediatric Blood & Cancer

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BackgroundClassical Hodgkin lymphoma (cHL) has excellent survival rates, but late effects are an issue and dictate modern approaches. We analyzed the clinical profile and outcome of cHL treated on a risk‐adapted approach aimed at reducing late effects while improving historical outcomes at our center.ProcedureChildren (≤15 years) consecutively treated for cHL from January 2013 through December 2016 were retrospectively analyzed. 18FDG‐PET‐CT–based staging and response assessment was done after two cycles for early response (ERA) and end of chemotherapy (late‐response assessment [LRA]) if not in complete response (CR; Deauville < 4) at ERA. Stages IA/IB/IIA were low risk (LR) and received two cycles of ABVD (adriamycin/bleomycin/vinblastine/dacarbazine). Stages IAX/IBX/IIAX/IIB/IIIA were intermediate risk (IR), and stages IIBE/IIBX/IIIAE/IIIAX/IIIB/IVA/IVB were high risk (HR). Both received two cycles of OEPA (oncocristine/etoposide/prednisolone/adriamycin). Those in ERA‐CR received two cycles of ABVD if LR, and two and four cycles of COPDac (cyclophosphamide/oncocristine/prednisolone/dacarbazine), respectively, for IR and HR. Involved‐field radiotherapy (IFRT) was given to bulky sites and ERA < CR. Those at LRA < CR (Deauville < 3) or progression at any stage received salvage regimens.ResultsIn the study period, 126 patients were identified who received the above protocol. There were 12 LR, and 114 advanced staged Hodgkin lymphoma (AHL) (18, IR; 96, HR) of which 91 (79.8%) had bulky sites. Eight (66.6%) LR and 93 (83%) AHL patients achieved ERA‐CRs. IFRT was given to 4 (33.3%) LR patients with ERA < CR, and 92 (80.7%) of AHL (91 bulky sites; 1 ERA < CR). At a median follow‐up of 31 months (range, 17–62), three‐year event‐free survival (EFS) and overall survival (OS) were both 100% for LR, and 94.4% (95% CI, 66.0%–99.2%) for IR, whereas for HR it was 90.3% (95% CI, 82.2%–94.8%) and 92.6% (95% CI, 85.2%–96.4%), respectively.ConclusionsChildren with HL have favorable outcomes with manageable toxicities when treated on a risk‐stratified and adapted approach. A high proportion of AHL have bulky disease necessitating IFRT, a concern that will have to be factored in future strategies.

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Management of Hodgkins Lymphoma: ICMR Consensus Document

Cited by 8 publications

References 31 publications

A Case Report on Stage Iv Hodgkin's Lymphoma

A Case Report on Stage Iv Hodgkin's Lymphoma

Editorial: Indian Guidelines for Treatment of Pediatric Malignancies

Clinical profile and outcome of classical Hodgkin lymphoma treated with a risk‐adapted approach in a tertiary cancer center in India

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