# Clinicopathologic patterns and treatment outcomes of pediatric classic hodgkin lymphoma in Ethiopian newly opened cancer treatment centers

## TL;DR

This study examines the clinicopathologic features and treatment outcomes of pediatric Hodgkin lymphoma in Ethiopia, showing promising survival rates despite challenges like treatment abandonment.

## Contribution

The study provides insights into pediatric Hodgkin lymphoma treatment outcomes in newly opened cancer centers in low-income countries, surpassing WHO survival targets.

## Key findings

- The 3-year event-free survival rate was 85.7% and overall survival rate was 98.6%.
- Treatment abandonment was a major challenge, with 31% of patients censored due to this issue.
- The treatment protocols used surpassed the WHO's 2030 survival target for pediatric cancers.

## Abstract

Pediatric Hodgkin lymphoma (PHL) is the most common lymphoreticular cancer in adolescents aged between 15-19 years. The survival of PHL is over 95% in developed countries with or without radiation therapy. Proper staging and risk stratification of PHL before initiation of treatment is fundamental for cure. Although outcomes for PHL in developed countries are excellent, survival in low-income countries remains lower. PHL is one of the WHO six indexed cancers with a target survival of >60% by 2030 globally. The aim of the study was to evaluate clinicopathologic characteristics and treatment outcomes of PHL at two treatment centers in Ethiopia.

Retrospective cohort study was conducted from January 1,2020 to December 29, 2024 at both Gondar and Jimma pediatric treatment centers. All children under 18 years of age were included in the study population. Data were extracted from each patient’s medical chart review and entered with Epi-info to be analyzed using SPSS version 26. Overall survival (OS) and event free survival (EFS) were calculated and analyzed using Kaplan-Meier estimates. P-value less than 0.05 was considered statistically significant.

The study included 70 pediatric HL patients. The median age was 8.5 years (range: 4-18 years) and 77.1% of patients were males. Cervical lymphadenopathy was the commonest clinical presentation. Nodular sclerosis was the commonest histology subtype (34.3%) followed by mixed cellularity while 27% had uncategorized histology. Overall, 54.3% of patients had localized (stage I and II) and 45.7% of patients had advanced disease (stage III and IV) at initial staging. Adriamycin, Bleomycin, Vincristine, Etoposide, Prednisolone and Cyclophosphamide (ABVE-PC) was the commonest chemotherapy regimen used in our cohort (61.4%). Only 10% (7) of patients received radiation therapy all from the intermediate to high-risk group. In our study, the 3-year EFS and OS rate of pediatric HL was 85.7% and 98.6% accounting abandonment as censored. Treatment abandonment remains the challenge for cure in our cohort accounting about 31% to be censored.

Our study showed that there was a trend towards earlier age at diagnosis of pediatric HL consistent with data from other developing countries. The treatment outcomes were good enough for newly opened centers in low-income countries with almost omission of radiotherapy, but treatment abandonment remains the challenge for cure as well affects the survival analysis in our cohorts. The treatment protocols used in this study surpassed the WHO indexed pediatric cancer survival target by 2030.