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Improved survival of pediatric Hodgkin lymphoma in developing countries using Combined-Modality Therapy with ABVD/COPDac: a single institution study in Iraq
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  • Usama Al-Jumaily,
  • Haider Shukur,
  • Mohammed Fawzi,
  • Mohammed Jawad,
  • Rasha Al-Safi,
  • Sabah Al-mosawy,
  • Tammam Al-Hashemy,
  • Safa Faraj
Usama Al-Jumaily
Iraq Ministry of Health

Corresponding Author:[email protected]

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Haider Shukur
Iraq Ministry of Health
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Mohammed Fawzi
Iraq Ministry of Health
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Mohammed Jawad
Iraq Ministry of Health
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Rasha Al-Safi
Iraq Ministry of Health
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Sabah Al-mosawy
Iraq Ministry of Health
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Tammam Al-Hashemy
Iraq Ministry of Health
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Safa Faraj
Iraq Ministry of Health
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Abstract

Purpose Data about Hodgkin lymphoma (HL) in developing countries are scattered. The aim of this study is to present the clinical features and outcome of children with HL using combined different chemotherapy regimens. Response-based approach was applied irrespective of risk stratification. Methods Patients aged 18 years and younger who were diagnosed with HL between January 2014 and December 2019 in the main tertiary hospital in Kerbalaa, Iraq, were recruited. Patients were stratified into three risk groups. Initial treatment with induction chemotherapy (i.e., 2 cycles of ABVD) was applied to all patients. Patients who achieved complete radiological response to induction chemotherapy continued with 4-6 cycles of ABVD; radiotherapy was omitted. Patients with slow early response received 3 cycles of COPDac after 3rd cycle of ABVD, followed by radiotherapy. Results Forty-one patients were enrolled in this study. The median age was 7 years. Fourteen (34.1%) patients were stage III, followed by stage I (29.3%). Eighteen patients had B symptoms. Initial splenic involvement was found in 11 patients. Approximately one third of patients had bulky disease (n = 12; 29.3%). The most common histology was mixed cellularity (n = 29). The median follow-up was 1.25 year (range from 0.5 to 2.0 years). The 4-year estimates of survival and EFS were 92% and 84% ±10%, respectively. Only bulky disease had a significant negative influence on the outcome. Conclusions Good outcomes for pediatric HL patients can be achieved in low and middle income countries. Response-based therapy approach is feasible to reduce long term treatment-related sequel.