94% survival in children with Hodgkin Lymphoma in India

New Delhi: A recent study supported by the National Society for Childhood Cancer, Cankids Kidscan with the Indian Pediatric Oncology Group (InPOG), shows an amazing 94% event free survival and 95.5% overall survival for early-stage Hodgkin Lymphoma (HL) in Children with Cancer in India, comparable to most developed countries.

Lymphoma is a common Cancer, In India out of 80,000 cases per year, approx. 4800 cases are HL. This cancer begins in the lymph system, which is part of the immune system that helps the body fight infection and disease. The most common sites are in the chest, neck and under the arm. In advanced disease, it can invade the bloodstream and can spread to other parts of the body such as the liver, lungs and/or bone marrow. In children it normally peaks in the 10–19 years age group. And is more common in boys than in girls, Male: Female ratio is 4.5:1. In India, we see relatively more young children below 5 years of age.

In this study 410 patients have participated from 27 centres over 30 months. Out of which 134 were classified as having early-stage disease and fifty-three of these had bulky disease.  At a median of 52 months since diagnosis, 5-year event-free survival (EFS) and overall survival (OS) is 94% and 95.5%, respectively. Treatment-related mortality and abandonment were <1%.

The study has proved that even with the AVBD Protocol, comparable results with developed countries can be achieved.

Dr. Amita Mahajan, Chair of InPOG Working Group on HL & a key investigator of the study said “The study also highlighted that unfortunately despite guidelines from IAP and WHO to the contrary ,about a third of patients with HL continue to receive treatment for tuberculosis empirically. InPOG and CanKids are now working to improve the outcomes of those who present with Advanced disease.”

The ABVD protocol has often raised concerns regarding late effects. In another study published recently by Dr. Sameer Bakhshi from IRCH AIIMS, the long-term toxicities and late effects of this ABVD protocol were evaluated.

154 pediatric HL survivors treated on ABVD were followed over a 10-year period for Cardiac Pulmonary & thyroid function as well as secondary malignancies. The study results showed ABVD to be safe for children at 10-year short follow-up.

On the Occasion of September-Lymphoma awareness month, Cankids organised the 1^st Fight Hodgkin Lymphoma India stakeholder meeting to define and draft the vision for Fight HL India -2025 and 2030, The webinar was attended by over 250 doctors, civil society members, parents & survivors of Hodgkin Lymphoma. Challenges and barriers on Access2Care and late side effects concerns were raised and plans & strategies for achieving universal survival outcomes for all Hodgkin Lymphoma patients discussed.

The doctors in the stakeholder meeting concluded from the AIIMS study that “None of the late effects in the pediatric HL survivors could be attributed directly to the chemotherapy regimen ABVD even after following up the patients for more than 10 years. While radiotherapy is an important part of the therapeutic armamentarium for HL, one would like to optimize the use of radiotherapy by using PET guided response assessment therapy for this cancer so as to minimize any late effects of radiotherapy”.

A Patient Advocacy group for HL “Harao LaseekaRog” headed by Hodgkin Lymphoma survivor Neha Saini was also launched.

Ms. Poonam Bagai, Chairman Cankids said “Better Survival rates would be achieved through better and uniform standards of care and treatment across the country. We have a goal to address this one cancer at a time. Today we have had the 1^st stakeholder meeting to fight HL India. Together we need to ensure Access2Care to 4800 HL patients across India by 2030.”

“Cankids is committed to support HL patients by enabling early detection, providing patient extended healthcare information, resource directories on sign & symptoms, What and Where to get diagnosis and from where treatment needs to be taken. We need to stop/reduce misdiagnosis as TB which results in delay for 5-6 months. Other than financial support, Cankids has dedicated supportive care for HL where emphasis is on timely and right diagnosis via PET & Fertility preservation to reduce risk factor. Survivors will be supported through the HL Patient Advocacy Group (PAG) and Passport2Life (P2L) for late side effects project.” Ms. Bagai further added.