Clinical characteristics and outcome of pediatric patients with stage IV Hodgkin lymphoma

Asim Belgaumi, Amani A. Al-Kofide, Yasser Khafaga, Nicey Joseph, Rubina Jamil-Malik, Khawar S. Siddiqui, Rajeh S. Sabbah

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


BACKGROUND AND OBJECTIVES: While treatment outcomes for patients with Hodgkin lymphoma (HL) have improved remarkably, patients with disseminated disease still have a poorer outcome. Stage IV HL is often reported with other 'advanced stage' categories, confusing the specific contribution of disease dissemination to the outcome. This single-institution report looks at characteristics and outcomes of this specific category. PATIENTS AND METHODS: The medical records of pediatric HL patients (<14 years) from 1975 through 2003 were retrospectively reviewed and the data analyzed. RESULTS: Stage IV patients (n=67) had more poor-risk characteristics than patients in stages I-III (n=300) (B symptoms 86.6% vs. 19.3%, bulky disease 57.6% vs. 45.5% and mediastinal mass 77.6% vs. 29.7%; P<.001 for all characteristics). The liver was the most common extralymphatic site (in 51.5% of patients with stage IV disease. Stage IV patients received chemotherapy (CT) alone (n=55) or combined modality therapy (CMT) (n=12). Fifty-four patients (80.6%) achieved complete remission, 2 (3%) partial remission, 10 (14.9%) had progressive disease and 1 was lost to follow up. Overall survival was 79.4% and event-free survival (EFS) was 63.9% at 5 years. There was a non-significant benefit for CMT (OS=91.7% v. 77.1 %, P=3; EFS=70.7% v. 62.7%, P=.3). Ten of 12 relapsed and only 1 of 10 progressive disease patients were salvaged. On multivariate analysis, failure to achieve complete remission with CT was associated with a poorer outcome. CONCLUSION: Stage IV disease is associated with poor risk features and confers a worse outcome than stage I-III disease. Achievement of complete remission with CT is an important prognostic feature. Slow responders may require novel and/or aggressive therapy to achieve complete remission.

Original languageEnglish
Pages (from-to)278-284
Number of pages7
JournalHematology/ Oncology and Stem Cell Therapy
Issue number1
Publication statusPublished - Feb 2009
Externally publishedYes


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