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

Abstract

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...

The feasibility of implementing Toronto childhood cancer stage guidelines and estimating the impact on outcome for childhood cancers in seven pediatric oncology units in sub‐Saharan Africa. A study from the Franco‐African Pediatric Oncology Group

“…1 The 1-year survival of 90% for Hodgkin lymphoma in this study supports previously published data for the group of 106 cases where 3-year survival was 82%. 35 Similarly, a previous GFAOP study found 3-year survival of 72% for 161 nephroblastoma cases.…”

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

“…An 80% OS was achieved in a study of patients in Burkina Faso, Cameroon, Mali, Madagascar and Senegal, low-income countries without access to radiotherapy. 20 Although seven patients were inappropriately treated on the intermediate-risk rather than the high-risk arm, the OS is still high.…”

“…The role of radiotherapy in HL continues to be explored, and research efforts are ongoing to better define the small group of patients that require this modality for cure. An 80% OS was achieved in a study of patients in Burkina Faso, Cameroon, Mali, Madagascar and Senegal, low‐income countries without access to radiotherapy 20 …”

Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage

“…100,101 The GFAOP has executed and published multiple prospective clinical trials, including several trials in which treatment protocols developed in Europe were modified by the group for implementation in resource-poor regions. 102 For example, implementation of the SIOP 2001 protocol for Wilms tumor demonstrated one of the highest survival rates in sub-Saharan Africa. 103,104 The GFAOP has asserted its commitment to leveraging multidisciplinary and multicenter support to construct the necessary infrastructure for future trials, and a third prospective multicenter study of a novel adapted treatment regimen was recently published.…”