Pediatric Hodgkin Lymphoma; Experience with Euronet Pediatric Hodgkin Lymphoma Protocol in a Developing Country

Objective: To analyse outcome of Paediatric Hodgkin Lymphoma (HL) patients treated with Euronet Paediatric Hodgkin Lymphoma treatment protocol in a developing country. Patients and Methods: This is a prospective study conducted at Paediatric Oncology department at Combined Military Hospital (CMH) Rawalpindi, Pakistan. All newly diagnosed cases of HL, less than 18years registered from January 2012 onwards that completed their treatment until 30th June 2018 were included. Data regarding age, sex, staging, histopathology and outcome were analysed. Results: Total 102 patients including 80 (78.4%) males and 22 (21.6%) females were analysed. The mean age was 7.54±2.77 years. B symptoms were present in 58 (56.9%) patients. Ten (9.8%) patients had stage I disease, 33 (32.4%) stage II, 41 (40.2%) stage III and 18 (17.6%) stage IV disease. Mixed cellularity was the commonest histological subtype seen in 74 (72.5%) patients. Involved field radiotherapy was given to 17 (16.7%) patients having inadequate response after 2 cycles of OEPA chemotherapy. Eight (7.8%) patients died of treatment related complications and 10 (9.8%) patients relapsed. Nine of the relapsed (90%) cases responded to 2 nd line treatment including one requiring autologous stem cell transplant. One relapsed patient died of progressive disease. Overall Survival (OS) and Event Free Survival (EFS) was 91.2% and 82.4% respectively. Conclusion: In Pakistan, mixed cellularity is the commonest HL subtype seen in young males. Long duration of disease before presentation, malnutrition, presence of symptoms, disease is