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Treatment of high-risk Hodgkin Lymphoma with a modified Stanford V regimen in the AHOPCA: substituting chemotherapy agents and hampered outcomes
  • +11
  • Sandra Luna-Fineman,
  • Mauricio Castellanos,
  • Metzger M,
  • Fulgencio Baez,
  • Armando Peña Hernandez,
  • Miguel Bonilla,
  • Soad Fuentes Alabi,
  • Rosa Nieves,
  • Jessica Blanco,
  • Emanuela Rossi,
  • Meenakshi Devidas,
  • Yichen Chen,
  • Magda Arreola,
  • Pedro de Alarcon
Sandra Luna-Fineman
University of Colorado Anschutz Medical Campus

Corresponding Author:sandra.luna-fineman@childrenscolorado.org

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Mauricio Castellanos
Unidad Nacional de Oncologia Pediatrica
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Metzger M
Medecins Sans Frontieres
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Fulgencio Baez
Oncología Pediátrica
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Armando Peña Hernandez
Hospital Escuela Universitario
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Miguel Bonilla
Hospital Nacional De Ninos Benjamin Bloom
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Soad Fuentes Alabi
Hospital Nacional De Ninos Benjamin Bloom
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Rosa Nieves
Hospital Infantil Robert Reid Cabral
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Jessica Blanco
Unidad Nacional de Oncologia Pediatrica
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Emanuela Rossi
Universita degli Studi di Milano-Bicocca Dipartimento di Medicina e Chirurgia
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Meenakshi Devidas
St Jude Children's Research Hospital
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Yichen Chen
St Jude Children's Research Hospital
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Magda Arreola
Unidad Nacional de Oncologia Pediatrica
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Pedro de Alarcon
University of Illinois Chicago College of Medicine
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Abstract

Background/Objectives: High-risk Hodgkin lymphoma (HRHL) in children is a curable with combined modality therapy. The AHOPCA is a consortium of cancer centers from Central America. In 2004, AHOPCA implemented a guideline with a short course of chemotherapy (mStanfordV), strict diagnostics and radiation guidelines, aimed at reducing abandonment and improving outcomes. Methods: Newly diagnosed children less than 18 years of age with high-risk HL (Ann Arbor stages: IIB, IIIB, IV) from AHOPCA centers were staged with chest X-ray, and ultrasound or CT. Therapy was a modified StanfordV (mStanfordV) substituting cyclophosphamide for mechlorethamine and involved field radiation. Results: Of 219 patients with HRHL, 181 patients were eligible and evaluable;146 (81%) were boys, 22% being less than 6 years; 43 were stage IIB, 84 IIIB and 54 IV. Thirty-one (17%) abandoned therapy, 28 (15%) progressed, 30 (17%) relapsed and 8 (4%) died of toxicity. Radiation guidelines were not followed. Five-year abandonment-sensitive event-free survival and overall survival (AS-EFS, AS-OS±SE) for the cohort were 46±4% and 56±4%; 5-year AS-OS for stages IIB, IIIB and IV was 76±7%, 59±7%, and 35±7% (p=0.0006). Conclusion: Despite instituting a short treatment guideline, it did not improve the abandonment rate (17%) and did not achieve the reported outcomes of StanfordV. The cyclophosphamide dose used to replace merchlorethamine was inadequate. Despite strict guidelines, the radiation therapy application was inaccuarate. Weekly chemotherapy may have adversely affected abandonment of therapy by increasing the burden of travel-time. Based on these results, AHOPCA established a new abandonment strategy and a new guideline.
28 Jun 2023Submission Checks Completed
28 Jun 2023Assigned to Editor
28 Jun 2023Submitted to Pediatric Blood & Cancer
28 Jun 2023Review(s) Completed, Editorial Evaluation Pending
28 Jun 2023Reviewer(s) Assigned
23 Jul 2023Editorial Decision: Revise Minor
19 Oct 2023Submission Checks Completed
19 Oct 2023Assigned to Editor
19 Oct 20231st Revision Received
10 Nov 2023Review(s) Completed, Editorial Evaluation Pending
10 Nov 2023Reviewer(s) Assigned
18 Nov 2023Editorial Decision: Accept