Outcome of second line therapy for pediatric patients with Hodgkin lymphoma who relapse following ABVD based therapy

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Background: Treatment outcomes for patients with newly diagnosed Hodgkin lymphoma have improved significantly. This, however, means that the number of patients relapsing following modern therapy is small and the information regarding their clinical characteristics and treatment outcome is limited.
Methods: Clinical information for patients with HL treated on an ABVD protocol were retrospectively collected. For those patients who suffered relapse or progression, data relating to this event, the treatment received and the outcome were collected and reviewed.
Results: Between May 1990 and December 2006 230 children (years) were treated for HL at our institution. 30 patients suffered treatment failure; 21 relapses and 9 progressions (PD). The median time to failure was 1.1years (0.05–7.29 yrs); 0.58 years for patients who progressed and 1.4 years for relapsing patients. 16 patients maintained their stage at relapse, 9 relapsed at a lower stage and 5 at a higher stage. 24 patients were subsequently treated with chemotherapy alone, one with XRT alone and 4 received CMT. One patient with progressive disease did not receive any salvage therapy. Chemotherapy protocols used included APPE (n=13), COPP (n=6), ESHAP (n=2), MOPP (n=2), COPPABV (n=2), MOPPABV (n=1) and ABVD/COPP (n=1). One patient with a nodular lymphocyte predominance HL progressed as a DLBCL and was treated on a NHL protocol. 10 patients subsequently underwent SCT (9 autologous and one allogeneic). 19/29 patients achieved CR post 2nd line therapy, while 5 each had PR and PD. OS at 6 years is 65.7%. Outcome for patients with PD was significantly worse than for those who relapsed (47.6% v. 73.2%; p=0.048). There was no difference in outcome for those patients who underwent SCT compared with those who did not (63% v. 66.4%; p=NS).
Conclusion: A majority of pediatric patients with HL who relapse following ABVD therapy can be salvaged. Outcome for patients following chemotherapy alone was no different from those who underwent SCT; therefore the necessity for SCT needs to be evaluated based on risk stratification.
Disclosures: No relevant conflicts of interest to declare.


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This work was published before the author joined Aga Khan University

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