Treating Hodgkin's Lymphoma in a Resource Poor Setting: Challenges and Outcome

摘要

Objectives: To assess the problems encountered in managing children with Hodgkin's Lymphoma (HL) in a resource poor Indian setting and to describe the clinical profile and outcome of these children. Materials and Methods: Case records of 184 previously untreated children (age 0-18yr) diagnosed to have HL at our centre between 1994 and 2012 were reviewed. The clinical characteristics, treatments offered and outcomes of these children were analyzed. Results: There were 162 boys and 22 girls with a median age of 8yrs. Sixty two percent children came from rural areas and 60% children were malnourished. Median duration of symptoms prior to treatment was 12 months (range 1-96 months). Eighty two percent children had advanced disease (Stage IIB-IV) at presentation. Abandonment rates were high (20%) and 12% children died during treatment. Treatment related complications were seen in a large number of patients and there was a high incidence of acquiring Hepatitis B and C during the treatment course. The 5-year overall survival and event-free survival rates were 79.4% and 53.1%, respectively. Conclusions: Children with HL coming to our centre tend to have a delayed presentation with advanced disease. Abandonment rates are high and a large proportion of patients experience complications during treatment. But despite these challenges, reasonably good outcomes were attained using simple chemotherapy protocols.