Outcome and Challenges in the Treatment of Pediatric Hodgkin Lymphoma With Euronet-PHL-C1 Protocol: Experience From a Resource-Limited Country

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2025-07-31 DOI:10.1002/cam4.71095

Elie Bechara, Toufic Eid, Arwa El-Dhuwaib, Hani Tamim, Dolly Noun, Raphah Borghol, Zaher Chakhachiro, Miguel R. Abboud, Samar Muwakkit

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Abstract

Background

The Euronet-PHL-C1 protocol has yielded excellent results for pediatric Hodgkin Lymphoma (HL), by omitting radiotherapy (RT) in early responders, thereby decreasing long-term toxicities. However, its application in resource-limited countries remains challenging. This study aims to evaluate patient outcomes using this protocol and the feasibility of omitting RT for early responders.

Methods

We conducted a retrospective analysis of 87 previously untreated pediatric HL patients at our Center from 2012 to 2022, following the Euronet-PHL-C1 protocol. RT was omitted for patients with an early rapid response at interim evaluation. Collected data were analyzed to determine survival outcomes and predictors of relapse.

Results

The mean age of the patients was 13 years, with 51.7% female. B-symptoms were present in 59.8% of the patients, while 37.9% had bulky disease, 57.1% had elevated erythrocyte sedimentation rate, and 42.5% had stage IV disease. RT was omitted for early rapid responders in 22.9% of the patients. The therapy was generally well tolerated, with only 36 episodes of febrile neutropenia and no treatment-related mortality. The 5-year progression-free survival and overall survival of the entire cohort were 89.3% and 97.6%, respectively. Nine patients relapsed, and two patients died. No independent predictors of event-free survival were identified.

Conclusion

The implementation of Euronet-HL protocol in our center provided excellent outcomes and a safety profile despite a few challenges. While RT can be removed in low-stage, rapid-responder patients, caution persists in resource-limited settings for those with advanced stage or bulky disease, highlighting the need for prospective trials to guide safe RT omission.

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Euronet-PHL-C1方案治疗儿童霍奇金淋巴瘤的结果和挑战：来自资源有限国家的经验

Euronet-PHL-C1方案通过在早期应答者中省略放疗（RT），从而降低长期毒性，在儿童霍奇金淋巴瘤（HL）治疗中取得了优异的效果。然而，它在资源有限的国家的应用仍然具有挑战性。本研究旨在评估使用该方案的患者结果，以及对早期应答者省略RT的可行性。方法：采用Euronet-PHL-C1方案，对我院2012年至2022年87例既往未接受治疗的儿童HL患者进行回顾性分析。在中期评估中，早期快速反应的患者省略了RT。收集的数据进行分析，以确定生存结果和复发的预测因素。结果患者平均年龄13岁，女性占51.7%。59.8%的患者存在b型症状，37.9%的患者有大体积疾病，57.1%的患者有红细胞沉降率升高，42.5%的患者有IV期疾病。22.9%的患者省略了早期快速反应者的RT。该疗法总体耐受良好，仅有36例发热性中性粒细胞减少症发作，无治疗相关死亡。整个队列的5年无进展生存率和总生存率分别为89.3%和97.6%。9例复发，2例死亡。没有发现独立的无事件生存预测因子。结论在本中心实施Euronet-HL协议，尽管存在一些挑战，但仍具有良好的疗效和安全性。虽然可以在低期、快速反应的患者中切除放疗，但在资源有限的情况下，对于那些晚期或大体积疾病的患者，仍需谨慎，这突出了前瞻性试验指导安全的RT省略的必要性。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.