Pretreatment Risk Factors Is a Strong Predictor of Outcome in Pediatric Hodgkin Lymphoma

Background: During the last decades, the prognosis of Hodgkin lymphoma (HL) has been improved significantly with the introduction of effective chemotherapy and the implementation of risk-adapted treatment approaches. Identification of reliable risk factors is crucial to guide treatment throughout the disease. Objectives: We aimed to identify independent predictors of event-free survival (EFS) in pediatric/ adolescent HL using clinical data known at diagnosis and treated with the ABVD regimen at our hospital. Design/Method: This is a retrospective study done at Children's cancer hospital Egypt from July 2007 to December 2017. ALL Patients with Classical HL were enrolled in the analysis. The chemotherapy backbone was ABVD +/- RTH. Data analysis included all pretreatment Demographics, clinicopathological characteristics, and Laboratory findings. PET scan was performed at baseline and after two cycles of chemotherapy. Treatment was not changed according to the results of the interim scan. Results: A total of 737 patients were eligible for analysis.The Five-years OS 94.9% and the EFS 87.8% in these patients. Pretreatment Significant univariate predictive factors for the EFS were: Age<9.5 (HR 0.421; p = 0.002),, ESR (HR 0.421; p = 0.002), Hemoglobin <10.5 (HR 1.373; p = 0.014), TLC >11,000 (HR 0.368; p = 0.000), Stage IV( p = 0.000) and treatment groups (HR 0.180; p = 0.000). Although the pathological subtypes has a diverse EFS;NS: 86.6% MS: 92.9% Lymphocyte rich: 87.5% and Lymphocyte depleted: 41.7%, Histology has shown to be a powerful independent predictor of outcome ( p = 0.000).In the multiple regression model, NS Histology and stage remained strong predictive factors with a p-value of 0.011and 0.026 respectively, In addition to the significance of the Albumin level (HR 0.047, p= 0.011). The interim PET, as well as RTH, were highly significant on both univariate (p= 0.000 and 0.0002 respectively) as well as multivariate analysis (p= 0.001and 0.000 respectively). Conclusion: Age; stage IV disease; white blood cell count, and hemoglobin level are independent predictors of survival that can significantly impact survival. Optimizing initial therapy may improve overall EFS for these patients. Although CHL pathology is a significant independent predictor of EFS, its subtypes have different EFS and OS, which should be translated into changes in the treatment approach.