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.