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 Table of Contents  
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 127-130

Hodgkin's lymphoma of the childhood: Experience of single hemato-oncology center

1 Department of Pediatric Hematologist/Oncologist, Child's Central Teaching Hospital, Baghdad, Iraq
2 Department of Pediatrician, Child's Central Teaching Hospital, Baghdad, Iraq

Date of Submission12-Jun-2020
Date of Acceptance13-Aug-2020
Date of Web Publication10-Nov-2020

Correspondence Address:
Dr. Entisar Hadi Al-Shammary
Child's Central Teaching Hospital, Baghdad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijh.ijh_30_20

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BACKGROUND: Hodgkin's lymphoma (HL) is a malignant lymphoma that accounts for approximately 7% of childhood cancers. The incidence of HL in childhood varies by age; it is the most common childhood cancer in the age group of 15–19 years.
OBJECTIVE: The objective of the study is to determine the clinical presentation and outcome of HL among children under 15 years of age.
PATIENTS AND METHODS: A retrospective study carried out at the hemato-oncology department of child's central teaching hospital included 46 HL patients under 15 years of age who were diagnosed over 6 years from January 2010 to December 2015. Demographic characteristics, histopathological and clinical features, treatment modalities, response to treatment, and outcome were obtained from the records files of the patients.
RESULTS: Among a total of 46 children with HL, there were 33 (71.7%) males and 13 (28.3%) females; the male-to-female ratio was 2.1:1; the mean age of this study was 8.3 years. Lymphadenopathy was the most common sign, with cervical lymph node being the most common primary site of involvement. 47.8% of the atients present with Stage II, and the mixed cellularity histopathological subtypes were the common recognized subtype. Event-free survival (EFS) is 78.3%, and overall survival (OS) was 95.5%.
CONCLUSION: Two-year OS (95.5%) and EFS (78.3%) of the HL patients were accepted as compared to other studies.

Keywords: Chemotherapy, childhood, Hodgkin's lymphoma, outcome

How to cite this article:
Al-Shammary EH, Al-Lami MJ. Hodgkin's lymphoma of the childhood: Experience of single hemato-oncology center. Iraqi J Hematol 2020;9:127-30

How to cite this URL:
Al-Shammary EH, Al-Lami MJ. Hodgkin's lymphoma of the childhood: Experience of single hemato-oncology center. Iraqi J Hematol [serial online] 2020 [cited 2021 Aug 4];9:127-30. Available from: https://www.ijhonline.org/text.asp?2020/9/2/127/300417

  Introduction Top

Hodgkin's lymphoma (HL) is a neoplasm characterized by relatively small numbers of clonal malignant Hodgkin/Reed–Sternberg (HRS) cells in an abundant reactive cellular background.[1],[2] The malignant HRS cells are derived from the germinal center B-cells but have characteristically lost the phenotypic features of these cells.[1],[2],[3] HL occurs most frequently in two separate age groups, the first being young adulthood (age 15–35 years) and the second being in those over 55 years old.[4] Event-free survival (EFS) rates and overall survival (OS) rates with the current treatment protocols among low-risk, intermediate-risk, and high-risk disease patients are approximately 92%, 85%, and 83%, and 98%, 93%, and 94%, respectively.[5],[6]

Aim of the study

The aim of the study is to determine clinical presentation, histopathological features, stages, and outcome of HL among children under 15 years of age.

  Patients and Methods Top

A retrospective study carried out at the child's central teaching hospital, over 6 months from May 1 to October 31, 2017, included 46 patients under 15 years of age who diagnosed with HL during the period from January 1, 2010, to December 31, 2015. The study was approved by review ethical committee of child central teaching hospital.

The information collected from the records file included age, gender, date of diagnosis, duration of disease before diagnosis, clinical presentation, stage of disease, histopathological types, investigations, treatment modality, and outcome.

Chemotherapy protocols that used for treatment of HL patients were (ABVD and ABV/COPP) chemotherapy regimen. ABVD regimen consists of (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) which used in 37 (80.4%) patients and ABV/COPP chemotherapy regemin consists of (Adiamycin, Bleomycin, Vinblastine/ alternating with Cyclophosphamide, Vincrestine, Prednisone, and Procarbazine) which used in 9 (19.6%) patients, according to drugs availability. 6-8 courses of (ABVD or ABV/COPP) were given every 28 days, each course contain two cycles, repeated every 14 days. Radiotherapy was received in 12 patients only. Evaluation of the patients depends on clinical assessment and imaging studies include ultrasound, computed tomography scan (in 15 patients), and positron emission tomography scan (in 26 patients). The follow-up after achieve remission was every 2 months for the first 6 months and then every 3 months for 2 years. The maximum period of follow-up was 2 years. A statistical analysis was done using IBM SPSS Statistics for Windows, Version 21 Armonk, NY: IBM Corp) evaluating mean and median.

  Results Top

Male-to-female ratio was 2.1:1; the mean age was 8.3 years. Lymphadenopathy (LAP) was the most common sign observed in 42 (91.3%) patients, and cervical lymph node was the most common primary site of involvement than the other lymphatic regions, the commonest histopathological subtype was Mixed cellularity, presented in (43.5%) of the patients and approximetely half of the patients had Stage II disease. as shown in [Table 1],[Table 2], [Table 3] and [Figure 1] respectively.
Table 1: Frequency of presenting signs and symptoms*

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Table 2: Distribution of patients according to the primary site

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Table 3: Frequency of histological types among Hodgkin's lymphoma patients (n=46)

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Figure 1: Staging of the patients in the study group

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Treatment outcome and survival

Of 46 patients who received chemotherapy, 2/46 (4.3%) patients abandoned, while 44/46 (95.7%) patients completed treatment. 40/44 (91%) of them got complete response and achieved remission while 4 (9%) patients got no/partial response. No patient died during the treatment. Of four patients who were no/partial response, three of them achieved remission after received treatment of resistant disease and one patient died [Table 4].
Table 4: Outcome of 44 Hodgkin's lymphoma patients who completed treatment

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Among 40 patients who were achieved complete remission, 36 (90%) of them got continuous complete remission and four (10%) of them got relapse within a period of maximum 2 years of follow-up (all of relapsed patients received rescue treatment of relapse protocols; three patients remained alive free of disease, and one patient died during the treatment due to progressive disease). Over a maximum 2 years' period of follow-up, the EFS was 78.3% and OS was 95.5% [Table 5], [Table 6] and [Figure 2], [Figure 3].
Table 5: Two-year event-free survival

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Table 6: Two-year overall survival

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Figure 2: Event-free survival of 2 years' duration

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Figure 3: Overall survival of 2 years' duration

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  Discussion Top

In this study that described the outcomes of patients with Hodgkin's disease in our institution, the age of the patients at presentation ranged from 3.6 to 14.8 years (median 8 years), which is comparable to the study of Sherief et al.[7] (median age 6 years). Males were more predominant than females, (male : female ratio 2.5:1); male predominant was reported by many studies in developing and developed countries.[7],[8],[9],[10] Majority of the patients presented with cervical LAP (91.3%) which was in agreement with several authors.[11],[12] In the current study, 6% of the patients had splenic involvement which was different from that mentioned in the study by Arya et al.,[13] in which splenic involvement was found in 15.6%. This study recorded that 41% of the patients had B symptoms, which approximate to the results of the study by Sherief et al.[7] (39% had B symptoms). Majority of the patients had classical HL with mixed cellularity subtype being the most common one, which is consistent with many other studies such as Laskar et al.[14] and Baez et al.[15] In this study, patients with advanced disease (Stage III and IV) were found to constitute 39.2% which approximate to the results of the study by Sherief et al.;[7] however, more than half of the patients have advanced disease (Stage III–IV) in less economically developed countries;[11],[15] in contrast to the Western countries, 75% of newly diagnosed patients have early disease at presentation (Stage I–II)[16] perhaps because of delayed diagnosis and referral. Overall Survival(OS), and Event Free Survival (EFS)of the current study were 95.4% and 78.3%, respectively which approximate to that mentioned in the study by Uysal KM et al.[17] in Turkey reported 5-year OS of 96% and EFS of 72%, Fadoo et al. in Pakistan [18] (OS 94%.). However, slightly lower than results of Fermé et al. (OS 98%),[6] Sherief et al. (OS 96.6% and EFS 84.7%),[7] Pourtsidis et al.[19] (OS 98% and EFS 86.2%). Angiotensin-converting enzyme (ACE) expression of the lymphoma-associated macrophages in the lymph nodes of HL may represent the point of cross-talk between renin-angiotensin system and lymphomagenesis. ACE could serve in the pathobiological function of the tissue-based macrophages in tumorigenesis of HL.[20]

  Conclusion Top

Cervical LAP was the most common clinical presentation of HL patients. Stage II disease and mixed cellularity histopathological subtype were common among HL patients. Two-year OS (95.5%) and EFS (78.3%) of HL patients were accepted in comparison to other studies.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Küppers R, Schwering I, Bräuninger A, Rajewsky K, Hansmann ML. Biology of Hodgkin's lymphoma. Ann Oncol 2002;13 Suppl 1:11-8.  Back to cited text no. 1
Schmitz R, Stanelle J, Hansmann ML, Küppers R. Pathogenesis of classical and lymphocyte-predominant Hodgkin lymphoma. Annu Rev Pathol 2009;4:151-74.  Back to cited text no. 2
Mathas S, Hartmann S, Küppers R. Hodgkin lymphoma: Pathology and biology. Semin Hematol 2016;53:139-47.  Back to cited text no. 3
Stein RS, Morgan DS. Hodgkin Lymphoma. In: Greer JP, Foerster J, Rodgers GM, eds. Wintrobe's Clinical Hematology. 12th Edition. Philadelphia, Lippincott Williams and Wilkins; 2009. p. 2313.  Back to cited text no. 4
Friedman DL. Hodgkin Lymphoma. In: Lanzkowsky P, editor. Manual of Pediatric Hematology and Oncology. Vol. 19. 5th ed. London NW1 7BY, UK: Elsevier Inc.; 2011. p. 599-623.  Back to cited text no. 5
Fermé C, Eghbali H, Meerwaldt JH, Rieux C, Bosq J, Berger F, et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med 2007;357:1916-27.  Back to cited text no. 6
Sherief LM, Elsafy UR, Abdelkhalek ER, Kamal NM, Elbehedy R, Hassan TH, et al. Hodgkin lymphoma in childhood: Clinicopathological features and therapy outcome at 2 centers from a developing country. Medicine (Baltimore) 2015;94:e670.  Back to cited text no. 7
Stefan DC, Stones D. How much does it cost to treat children with Hodgkin lymphoma in Africa? Leuk Lymphoma 2009;50:196-9.  Back to cited text no. 8
Friedmann AM, Hudson MM, Weinstein HJ, Donaldson SS, Kun L, Tarbell NJ, et al. Treatment of unfavorable childhood Hodgkin's disease with VEPA and low-dose, involved-field radiation. J Clin Oncol 2002;20:3088-94.  Back to cited text no. 9
Engel M, Essop MF, Close P, Hartley P, Pallesen G, Sinclair-Smith C. Improved prognosis of Epstein-Barr virus associated childhood Hodgkin's lymphoma: Study of 47 South African cases. J Clin Pathol 2000;53:182-6.  Back to cited text no. 10
Arya LS, Dinand V, Thavaraj V, Bakhshi S, Dawar R, Rath GK, et al. Hodgkin's disease in Indian children: Outcome with chemotherapy alone. Pediatr Blood Cancer 2006;46:26-34.  Back to cited text no. 11
Togo B, Traoré F, Togo AP, Traoré CB, Dumke K, Diawara M, et al. Hodgkin lymphoma at the paediatric oncology unit of Gabriel Touré Teaching Hospital, Bamako, Mali: 5-year experience. Adv Hematol 2011;2011:327237.  Back to cited text no. 12
Arya LS, Dinand V, Bakhshi S, Thavaraj V, Singh R, Dawar R. Significance of splenomegaly in childhood Hodgkin disease. J Pediatr Hematol Oncol 2004;26:807-12.  Back to cited text no. 13
Laskar S, Gupta T, Vimal S, Muckaden MA, Saikia TK, Pai SK, et al. Consolidation radiation after complete remission in Hodgkin's disease following six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy: Is there a need? J Clin Oncol 2004;22:62-8.  Back to cited text no. 14
Baez F, Ocampo E, Conter V, Flores A, Gutierrez T, Malta A, et al. Treatment of childhood Hodgkin's disease with COPP or COPP-ABV (hybrid) without radiotherapy in Nicaragua. Ann Oncol 1997;8:247-50.  Back to cited text no. 15
Schellong G, Pötter R, Brämswig J, Wagner W, Prott FJ, Dörffel W, et al. High cure rates and reduced long-term toxicity in pediatric Hodgkin's disease: The German-Austrian multicenter trial DAL-HD-90. The German-Austrian Pediatric Hodgkin's Disease Study Group. J Clin Oncol 1999;17:3736-44.  Back to cited text no. 16
Mutafoǧlu-Uysal K, Çetingöz R, Güneş D, et al. Clinical characteristics and therapy outcome of pediatric Hodgkin's lymphoma-A single centre experience from the west part of Turkey. Turk J Cancer 2007;37:98-108.  Back to cited text no. 17
Fadoo Z, Belgaumi A, Alam M, Azam I, Naqvi A. Pediatric lymphoma: A 10-year experience at a tertiary care hospital in Pakistan. J Pediatr Hematol Oncol 2010;32:e14-8.  Back to cited text no. 18
Pourtsidis A, Doganis D, Baka M, Bouhoutsou D, Varvoutsi M, Synodinou M, et al. Differences between younger and older patients with childhood Hodgkin lymphoma. Pediatr Hematol Oncol 2013;30:532-6.  Back to cited text no. 19
Koca E, Haznedaroglu IC, Uner A, Sayinalp N, Saglam AE, Goker H, et al. Angiotensin-converting enzyme expression of the lymphoma-associated macrophages in the lymph nodes of Hodgkin's disease. J Natl Med Assoc 2007;99:1243-4, 1246-7.  Back to cited text no. 20


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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