Subjects
AHOPCA HRHL 2004 enrolled subjects between January 2004 and August 2009.
Consecutive patients, less than 18 years of age, with histologically
confirmed previously untreated high-risk (Table 1s); defined as modified
Ann Arbor stages IIB, IIIB and IV, irrespective of bulky disease
[mediastinum > 1/3 diameter, or peripheral lymph nodes
greater then 6cm]) HRHL (classical and nodular lymphocyte predominant)
presenting to one of the AHOPCA centers (El Salvador, Guatemala,
Honduras, Nicaragua and Dominican Republic), were treated according to
the guidelines and are the subject of this report. Patients previously
treated for HL or seropositive for the human immunodeficiency virus were
excluded. As a treatment guideline to improve quality of diagnosis and
treatment, all countries consented for therapy according to the local
policies.
Prior to starting therapy, all patients underwent a complete medical
history, physical examination and evaluation by imaging and laboratory
studies consisting of complete blood cell count, erythrocyte
sedimentation rate (ESR), blood chemistries including renal and liver
function studies, and albumin. All underwent an excisional biopsy from
an easily accessible lymph node or a “trucut” biopsy of the
mediastinum or abdominal mass. Pathology was reported for El Salvador,
Guatemala and Dominican Republic with immunohistochemistry’s (CD30,
CD15, CD20) to confirm diagnosis of HL (classical histology or nodular
lymphocyte predominant). Honduras and Nicaragua reported diagnosis using
morphology only. Patients with B symptoms or advanced disease had a
bilateral bone marrow biopsy performed.