Outcome and toxicity of ifosfamide, carboplatin, and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory Hodgkin’s lymphoma
BackgroundPediatric classical Hodgkin lymphoma (CHL) is a curable disease; however, the optimal salvage regimen is unclear for relapsed/refractory (R/R) disease. This study aimed to compare response rates, toxicity, event-free survival (EFS), and overall survival (OS) of ifosfamide, carboplatin, and...
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1153128/full |
| _version_ | 1797794260004634624 |
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| author | Ahmed Mahdy Asmaa Hamoda Asmaa Hamoda Ahmed Zaher Ahmed Zaher Eman Khorshed Eman Khorshed Madeha Elwakeel Madeha Elwakeel Omneya Hassanein Iman Sidhom Iman Sidhom |
| author_facet | Ahmed Mahdy Asmaa Hamoda Asmaa Hamoda Ahmed Zaher Ahmed Zaher Eman Khorshed Eman Khorshed Madeha Elwakeel Madeha Elwakeel Omneya Hassanein Iman Sidhom Iman Sidhom |
| author_sort | Ahmed Mahdy |
| collection | DOAJ |
| description | BackgroundPediatric classical Hodgkin lymphoma (CHL) is a curable disease; however, the optimal salvage regimen is unclear for relapsed/refractory (R/R) disease. This study aimed to compare response rates, toxicity, event-free survival (EFS), and overall survival (OS) of ifosfamide, carboplatin, and etoposide (ICE) with gemcitabine and vinorelbine (GV) regimen after first-line doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) in pediatric patients with R/R CHL.MethodsThis is a retrospective cohort study of 132 pediatric patients with R/R CHL treated from July 2012 to December 2020 with ICE (n = 82) or GV (n = 50).ResultsThe median age at relapse was 13.9 years, and 68.2% were men. Rates of complete response, partial response, and progressive disease before consolidation were 50.6%, 3.7%, and 45.7% for ICE and 28.5%, 0%, and 71.5% for GV (P = 0.011). By multivariate analysis, regimen (P = 0.002), time to relapse (P = 0.0001), and B-symptoms (P = 0.002) were independent factors to lower response rates. Hematological toxicity, electrolyte disturbance, hemorrhagic cystitis, infectious complications, and hospital admission for fever neutropenia were statistically significant higher for the ICE regimen. Treatment-related mortalities were 2.4% for ICE and 2% for GV (P = 0.86). The 3-year EFS was 39.3% ± 11.4% for ICE and 24.9% ± 12.5% for GV (P = 0.0001), while 3-year OS was 69.3% ± 10.6% and 74% ± 12.9% (P = 0.3), respectively. By multivariate analysis, regimen (P = 0.0001), time to relapse (P = 0.011), B-symptoms (P = 0.001), and leukocytosis (P = 0.007) were significant for EFS, while anemia (P = 0.008), and progressive disease on early response evaluation (P = 0.022) were significant for OS.ConclusionsThe ICE regimen had a better overall response rate and EFS, but higher toxicity, than GV; however, OS and mortality were similar. |
| first_indexed | 2024-03-13T02:59:08Z |
| format | Article |
| id | doaj.art-f42a496c20404494ae4ee3dd45c83145 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-13T02:59:08Z |
| publishDate | 2023-06-01 |
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| series | Frontiers in Oncology |
| spelling | doaj.art-f42a496c20404494ae4ee3dd45c831452023-06-27T17:25:11ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-06-011310.3389/fonc.2023.11531281153128Outcome and toxicity of ifosfamide, carboplatin, and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory Hodgkin’s lymphomaAhmed Mahdy0Asmaa Hamoda1Asmaa Hamoda2Ahmed Zaher3Ahmed Zaher4Eman Khorshed5Eman Khorshed6Madeha Elwakeel7Madeha Elwakeel8Omneya Hassanein9Iman Sidhom10Iman Sidhom11Pediatric Oncology Department, Children's Cancer Hospital Egypt, Cairo, EgyptPediatric Oncology Department, Children's Cancer Hospital Egypt, Cairo, EgyptPediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, EgyptNuclear Medicine Department, National Cancer Institute, Cairo University, Cairo, EgyptNuclear Medicine Department, Children's Cancer Hospital Egypt, Cairo, EgyptSurgical Pathology Department, National Cancer Institute, Cairo University, Cairo, EgyptSurgical Pathology Department, Children's Cancer Hospital Egypt, Cairo, EgyptRadiology Department, National Cancer Institute, Cairo University, Cairo, EgyptRadiology Department, Children's Cancer Hospital Egypt, Cairo, EgyptClinical Research Department, Children's Cancer Hospital Egypt, Cairo, EgyptPediatric Oncology Department, Children's Cancer Hospital Egypt, Cairo, EgyptPediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, EgyptBackgroundPediatric classical Hodgkin lymphoma (CHL) is a curable disease; however, the optimal salvage regimen is unclear for relapsed/refractory (R/R) disease. This study aimed to compare response rates, toxicity, event-free survival (EFS), and overall survival (OS) of ifosfamide, carboplatin, and etoposide (ICE) with gemcitabine and vinorelbine (GV) regimen after first-line doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) in pediatric patients with R/R CHL.MethodsThis is a retrospective cohort study of 132 pediatric patients with R/R CHL treated from July 2012 to December 2020 with ICE (n = 82) or GV (n = 50).ResultsThe median age at relapse was 13.9 years, and 68.2% were men. Rates of complete response, partial response, and progressive disease before consolidation were 50.6%, 3.7%, and 45.7% for ICE and 28.5%, 0%, and 71.5% for GV (P = 0.011). By multivariate analysis, regimen (P = 0.002), time to relapse (P = 0.0001), and B-symptoms (P = 0.002) were independent factors to lower response rates. Hematological toxicity, electrolyte disturbance, hemorrhagic cystitis, infectious complications, and hospital admission for fever neutropenia were statistically significant higher for the ICE regimen. Treatment-related mortalities were 2.4% for ICE and 2% for GV (P = 0.86). The 3-year EFS was 39.3% ± 11.4% for ICE and 24.9% ± 12.5% for GV (P = 0.0001), while 3-year OS was 69.3% ± 10.6% and 74% ± 12.9% (P = 0.3), respectively. By multivariate analysis, regimen (P = 0.0001), time to relapse (P = 0.011), B-symptoms (P = 0.001), and leukocytosis (P = 0.007) were significant for EFS, while anemia (P = 0.008), and progressive disease on early response evaluation (P = 0.022) were significant for OS.ConclusionsThe ICE regimen had a better overall response rate and EFS, but higher toxicity, than GV; however, OS and mortality were similar.https://www.frontiersin.org/articles/10.3389/fonc.2023.1153128/fullrelapsed/refractory pediatric CHLICEGVtoxicityoutcome |
| spellingShingle | Ahmed Mahdy Asmaa Hamoda Asmaa Hamoda Ahmed Zaher Ahmed Zaher Eman Khorshed Eman Khorshed Madeha Elwakeel Madeha Elwakeel Omneya Hassanein Iman Sidhom Iman Sidhom Outcome and toxicity of ifosfamide, carboplatin, and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory Hodgkin’s lymphoma Frontiers in Oncology relapsed/refractory pediatric CHL ICE GV toxicity outcome |
| title | Outcome and toxicity of ifosfamide, carboplatin, and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory Hodgkin’s lymphoma |
| title_full | Outcome and toxicity of ifosfamide, carboplatin, and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory Hodgkin’s lymphoma |
| title_fullStr | Outcome and toxicity of ifosfamide, carboplatin, and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory Hodgkin’s lymphoma |
| title_full_unstemmed | Outcome and toxicity of ifosfamide, carboplatin, and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory Hodgkin’s lymphoma |
| title_short | Outcome and toxicity of ifosfamide, carboplatin, and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory Hodgkin’s lymphoma |
| title_sort | outcome and toxicity of ifosfamide carboplatin and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory hodgkin s lymphoma |
| topic | relapsed/refractory pediatric CHL ICE GV toxicity outcome |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1153128/full |
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