Improving the prognosis of pediatric hodgkin lymphoma in developing countries

A moroccan society of pediatric hematology and oncology study

Laila Hessissen, Rachida Khtar, Abdellah Madani, Maria El Kababri, Amina Kili, Mhamed Harif, Mohamed Khattab, Souha Sahraoui, Nouredine Benjaafar, Samir Ahid, Scott Howard, Said Benchekroun

Research output: Contribution to journalArticle

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Abstract

Background: The event-free survival (EFS) of children with Hodgkin lymphoma (HL) exceeds 80% in high income countries (HIC), but little is known about this rate in developing countries. Procedure: A prospective national protocol for children with classical HL was implemented in Morocco to increase EFS by careful risk stratification, providing each cycle of therapy on time, decreasing treatment abandonment, improving communication among healthcare providers, and improving data collection. Patients were stratified into a favorable risk group (Ann Arbor stages I and II, no B symptoms, no bulky disease, and no contiguous (E) lesions) and received four cycles of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) or an unfavorable risk group (all others) who received two cycles of vincristine, procarbazine, prednisone, and doxorubicin (OPPA) and four cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP). All patients received involved-field radiotherapy 25.5Gy after completion of chemotherapy. EFS was calculated counting death, relapse/resistant disease, and abandonment as events. Results: From February 2004 to December 2007, 160 patients enrolled; 138 (86%) had unfavorable risk features. Twenty patients (12.5%) abandoned treatment, 16 relapsed or had resistant disease, and 6 died (3 unexplained, 2 varicella, and 1 suicide). The estimated 5-year EFS was 70±4% and overall survival 88±3%. Conclusions: Good outcomes for pediatric HL patients can be achieved in LMIC using a multidisciplinary team approach, uniform protocol-based therapy, twinning partnership among oncology units in-country and abroad, and a data collection system to monitor compliance and identify gaps in care.

Original languageEnglish (US)
Pages (from-to)1464-1469
Number of pages6
JournalPediatric Blood and Cancer
Volume60
Issue number9
DOIs
StatePublished - Sep 1 2013
Externally publishedYes

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Hematology
Hodgkin Disease
Developing Countries
Disease-Free Survival
Pediatrics
Prednisone
Procarbazine
Vincristine
Doxorubicin
Morocco
Chickenpox
Vinblastine
Therapeutics
Information Systems
Methotrexate
Health Personnel
Cyclophosphamide
Suicide
Compliance
Radiotherapy

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Improving the prognosis of pediatric hodgkin lymphoma in developing countries : A moroccan society of pediatric hematology and oncology study. / Hessissen, Laila; Khtar, Rachida; Madani, Abdellah; El Kababri, Maria; Kili, Amina; Harif, Mhamed; Khattab, Mohamed; Sahraoui, Souha; Benjaafar, Nouredine; Ahid, Samir; Howard, Scott; Benchekroun, Said.

In: Pediatric Blood and Cancer, Vol. 60, No. 9, 01.09.2013, p. 1464-1469.

Research output: Contribution to journalArticle

Hessissen, L, Khtar, R, Madani, A, El Kababri, M, Kili, A, Harif, M, Khattab, M, Sahraoui, S, Benjaafar, N, Ahid, S, Howard, S & Benchekroun, S 2013, 'Improving the prognosis of pediatric hodgkin lymphoma in developing countries: A moroccan society of pediatric hematology and oncology study', Pediatric Blood and Cancer, vol. 60, no. 9, pp. 1464-1469. https://doi.org/10.1002/pbc.24534
Hessissen, Laila ; Khtar, Rachida ; Madani, Abdellah ; El Kababri, Maria ; Kili, Amina ; Harif, Mhamed ; Khattab, Mohamed ; Sahraoui, Souha ; Benjaafar, Nouredine ; Ahid, Samir ; Howard, Scott ; Benchekroun, Said. / Improving the prognosis of pediatric hodgkin lymphoma in developing countries : A moroccan society of pediatric hematology and oncology study. In: Pediatric Blood and Cancer. 2013 ; Vol. 60, No. 9. pp. 1464-1469.
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abstract = "Background: The event-free survival (EFS) of children with Hodgkin lymphoma (HL) exceeds 80{\%} in high income countries (HIC), but little is known about this rate in developing countries. Procedure: A prospective national protocol for children with classical HL was implemented in Morocco to increase EFS by careful risk stratification, providing each cycle of therapy on time, decreasing treatment abandonment, improving communication among healthcare providers, and improving data collection. Patients were stratified into a favorable risk group (Ann Arbor stages I and II, no B symptoms, no bulky disease, and no contiguous (E) lesions) and received four cycles of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) or an unfavorable risk group (all others) who received two cycles of vincristine, procarbazine, prednisone, and doxorubicin (OPPA) and four cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP). All patients received involved-field radiotherapy 25.5Gy after completion of chemotherapy. EFS was calculated counting death, relapse/resistant disease, and abandonment as events. Results: From February 2004 to December 2007, 160 patients enrolled; 138 (86{\%}) had unfavorable risk features. Twenty patients (12.5{\%}) abandoned treatment, 16 relapsed or had resistant disease, and 6 died (3 unexplained, 2 varicella, and 1 suicide). The estimated 5-year EFS was 70±4{\%} and overall survival 88±3{\%}. Conclusions: Good outcomes for pediatric HL patients can be achieved in LMIC using a multidisciplinary team approach, uniform protocol-based therapy, twinning partnership among oncology units in-country and abroad, and a data collection system to monitor compliance and identify gaps in care.",
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T1 - Improving the prognosis of pediatric hodgkin lymphoma in developing countries

T2 - A moroccan society of pediatric hematology and oncology study

AU - Hessissen, Laila

AU - Khtar, Rachida

AU - Madani, Abdellah

AU - El Kababri, Maria

AU - Kili, Amina

AU - Harif, Mhamed

AU - Khattab, Mohamed

AU - Sahraoui, Souha

AU - Benjaafar, Nouredine

AU - Ahid, Samir

AU - Howard, Scott

AU - Benchekroun, Said

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Background: The event-free survival (EFS) of children with Hodgkin lymphoma (HL) exceeds 80% in high income countries (HIC), but little is known about this rate in developing countries. Procedure: A prospective national protocol for children with classical HL was implemented in Morocco to increase EFS by careful risk stratification, providing each cycle of therapy on time, decreasing treatment abandonment, improving communication among healthcare providers, and improving data collection. Patients were stratified into a favorable risk group (Ann Arbor stages I and II, no B symptoms, no bulky disease, and no contiguous (E) lesions) and received four cycles of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) or an unfavorable risk group (all others) who received two cycles of vincristine, procarbazine, prednisone, and doxorubicin (OPPA) and four cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP). All patients received involved-field radiotherapy 25.5Gy after completion of chemotherapy. EFS was calculated counting death, relapse/resistant disease, and abandonment as events. Results: From February 2004 to December 2007, 160 patients enrolled; 138 (86%) had unfavorable risk features. Twenty patients (12.5%) abandoned treatment, 16 relapsed or had resistant disease, and 6 died (3 unexplained, 2 varicella, and 1 suicide). The estimated 5-year EFS was 70±4% and overall survival 88±3%. Conclusions: Good outcomes for pediatric HL patients can be achieved in LMIC using a multidisciplinary team approach, uniform protocol-based therapy, twinning partnership among oncology units in-country and abroad, and a data collection system to monitor compliance and identify gaps in care.

AB - Background: The event-free survival (EFS) of children with Hodgkin lymphoma (HL) exceeds 80% in high income countries (HIC), but little is known about this rate in developing countries. Procedure: A prospective national protocol for children with classical HL was implemented in Morocco to increase EFS by careful risk stratification, providing each cycle of therapy on time, decreasing treatment abandonment, improving communication among healthcare providers, and improving data collection. Patients were stratified into a favorable risk group (Ann Arbor stages I and II, no B symptoms, no bulky disease, and no contiguous (E) lesions) and received four cycles of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) or an unfavorable risk group (all others) who received two cycles of vincristine, procarbazine, prednisone, and doxorubicin (OPPA) and four cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP). All patients received involved-field radiotherapy 25.5Gy after completion of chemotherapy. EFS was calculated counting death, relapse/resistant disease, and abandonment as events. Results: From February 2004 to December 2007, 160 patients enrolled; 138 (86%) had unfavorable risk features. Twenty patients (12.5%) abandoned treatment, 16 relapsed or had resistant disease, and 6 died (3 unexplained, 2 varicella, and 1 suicide). The estimated 5-year EFS was 70±4% and overall survival 88±3%. Conclusions: Good outcomes for pediatric HL patients can be achieved in LMIC using a multidisciplinary team approach, uniform protocol-based therapy, twinning partnership among oncology units in-country and abroad, and a data collection system to monitor compliance and identify gaps in care.

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