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