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

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.