Outcome of Children With Hodgkin Lymphoma Treated With a Response-Adapted Strategy: A 10-Year Single Center Experience in Iraq Publisher



Abdul Raouf Al Safi R ; Al Mosawy S ; Al Jumaily U ; Faraj S ; Alqanbar M F ; Al Khateeb D A ; Abdul Jaleel M I ; Jabbar S
Source: Indian Journal of Hematology and Blood Transfusion Published:2026

Abstract

Hodgkin lymphoma (HL) is the most common form of lymphoma in children. While HL can be effectively treated with chemotherapy and radiation therapy, long-term survivors experience side effects of these treatments. Therefore, in recent times, there have been efforts to ensure that HL in children is treated with a response-adapted strategy without compromising its curability. There have been limited reports on the outcome of HL in low- and middle-income countries. The aim of this study was to evaluate the clinical outcome of pediatric HL treated with a response-adapted strategy in Iraq. This was a retrospective observational study of children aged ≤ 18 years diagnosed with histologically confirmed HL. The children were treated at the Primary Cancer Center in Kerbala, Iraq, between January 2014 and December 2024. The children were staged using the Ann Arbor staging system. The children were classified as low, intermediate, or high risk. All children received two courses of ABVD chemotherapy. Those with complete remission received ABVD chemotherapy, while those with partial remission received COPDac chemotherapy and radiation therapy. The survival outcome was determined using the Kaplan-Meier method, while the prognostic factors were determined using the log-rank test and Cox regression. Seventy-four patients were included in the study. The median age was 8 years (range 2.5–16 years). Male patients accounted for 59.5%. Mixed cellularity was the commonest type of HL (70.3%), and cervical lymphadenopathy was the commonest presenting feature (93.2%). Patients presenting in stage III accounted for 36.5% of the patients. Low-risk patients accounted for 40.5%. B symptoms and bulky disease were present in 41.9% and 36.5% of the patients, respectively. After the administration of two cycles of ABVD, 37.8% achieved complete response (CR), whereas 62.2% achieved partial response (PR). Forty-three patients received combined chemotherapy (ABVD + COPDac), and 27 patients received radiotherapy. The 5-year OS and EFS rates were 84.3% and 79.1%, respectively. Statistically significant differences in EFS were found for the stage of the disease, risk groups, B symptoms, and bulky disease (p < 0.05). In the multivariate analysis, bulky disease was the only prognostic indicator for survival (p = 0.007). The response-adapted treatment with ABVD and COPDac chemotherapy regimens suggested favorable survival outcomes for children with Hodgkin lymphoma. Nevertheless, the results should be viewed with caution given the influence of logistical issues in the omission of radiotherapy. © The Author(s), under exclusive licence to The Indian Society of Hematology & Blood Transfusion 2026.