Amita Mahajan1, Sameer Bakhshi2, Manisha Singh3, Rachna Seth4, Nishant Verma5, Sandeep Jain6, Venkatraman Radhakrishnan7, Piali Mandal8, Ramandeep Singh Arora9, Veronique Dinand10, Manas Kalra11, Gauri Kapoor6, Mohammad Sajid3, Rakesh Kumar12, Saumyaranjan Mallick13, Ankit Taluja14, Jagdish Chandra8. 1. Department of Pediatric Oncology, Indraprastha Apollo Hospital, New Delhi, 110076, India. mahajanamita1@gmail.com. 2. Department of Pediatric Oncology, All India Institute of Medical Sciences, New Delhi, India. 3. Department of Medical and Pediatric Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India. 4. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. 5. Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India. 6. Department of Pediatric Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India. 7. Department of Pediatric Oncology, Cancer Institute, Adyar, Chennai, Tamil Nadu, India. 8. Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India. 9. Department of Pediatric Oncology, Max Super Specialty Hospital, New Delhi, India. 10. Palliative and Supportive Unit, BJ Wadia Hospital, Mumbai, Maharashtra, India. 11. Department of Pediatric Oncology, Sir Ganga Ram Hospital, New Delhi, India. 12. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India. 13. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India. 14. , Cankids Kidscan, New Delhi, India.
Abstract
OBJECTIVE: To evaluate the proportion of patients who received empirical treatment with antitubercular therapy (ATT) prior to the diagnosis of Hodgkin lymphoma (HL) in the first multicentric, prospective study on HL from India, and to assess its impact on extent of disease at diagnosis and outcomes. METHODS: Children < 18 y with biopsy proven HL were enrolled in InPOG-HL-15-01. Along with other clinical and epidemiological data, history of prior treatment with ATT was documented. All patients received treatment as per a risk-stratified, response-adapted strategy. RESULTS: Out of 396, 115 (29%) children had received ATT prior to establishing a definitive diagnosis of HL. This cohort presented with advanced-stage disease (p = 0.001) and B symptoms (p = 0.001) in a higher proportion of cases. Consequently, those children were more likely to receive 6 rather than 4 cycles of chemotherapy (p = 0.001). They were more likely to have infradiaphragmatic involvement (p = 0.001). Overall survival and event-free survival were not different. CONCLUSION: Empirical treatment with ATT in children presenting with lymphadenopathy continues to be practiced widely in India. The delay in diagnosis may contribute to children presenting with advanced-stage disease warranting more intensive treatment for successful outcomes.
OBJECTIVE: To evaluate the proportion of patients who received empirical treatment with antitubercular therapy (ATT) prior to the diagnosis of Hodgkin lymphoma (HL) in the first multicentric, prospective study on HL from India, and to assess its impact on extent of disease at diagnosis and outcomes. METHODS: Children < 18 y with biopsy proven HL were enrolled in InPOG-HL-15-01. Along with other clinical and epidemiological data, history of prior treatment with ATT was documented. All patients received treatment as per a risk-stratified, response-adapted strategy. RESULTS: Out of 396, 115 (29%) children had received ATT prior to establishing a definitive diagnosis of HL. This cohort presented with advanced-stage disease (p = 0.001) and B symptoms (p = 0.001) in a higher proportion of cases. Consequently, those children were more likely to receive 6 rather than 4 cycles of chemotherapy (p = 0.001). They were more likely to have infradiaphragmatic involvement (p = 0.001). Overall survival and event-free survival were not different. CONCLUSION: Empirical treatment with ATT in children presenting with lymphadenopathy continues to be practiced widely in India. The delay in diagnosis may contribute to children presenting with advanced-stage disease warranting more intensive treatment for successful outcomes.