Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa

Jennifer Geel, Anel Van Zyl, Jan du Plessis, Marc Hendricks, Yasmin Goga, Amy Carr, Beverley Neethling, Artsiom Hramyka, Fareed Omar, Rema Mathew, Lizette Louw, Thanushree Naidoo, Thandeka Ngcana, Tanya Schickerling, Vutsh Netshituni , E Madzhia, Liezl du Plessis, Tom Kelsey*, Daynia Ballot, Moni Metzger

*Corresponding author for this work

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Historic South African 5-year overall survival (OS) rates for Hodgkin lymphoma (HL) from 2000 to 2010 were 46% and 84% for human immunodeficiency virus (HIV)-positive and HIV-negative children, respectively. We investigated whether a harmonised treatment protocol using risk stratification and response-adapted therapy could increase the OS of childhood and adolescent HL.

Seventeen units prospectively enrolled patients less than 18 years, newly diagnosed with classical HL onto a risk-stratified, response-adapted treatment protocol from July 2016 to December 2022. Low- and intermediate-risk patients received four and six courses of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), respectively. High-risk patients received two courses of ABVD, followed by four courses of cyclophosphamide, vincristine, prednisone, and dacarbazine (COPDac). Those with a slow early response and bulky disease received consolidation radiotherapy. HIV-positive patients could receive granulocyte colony-stimulating factor and less intensive therapy if stratified as high risk, at the treating clinician's discretion. Kaplan–Meier survival analysis was performed to determine 2-year OS and Cox regression to elucidate prognostic factors.

The cohort comprised 132 patients (19 HIV-positive, 113 HIV-negative), median age of 9.7 years, with a median follow-up of 2.2 years. Risk grouping comprised nine (7%) low risk, 36 (27%) intermediate risk and 87 (66%) high risk, with 71 (54%) rapid early responders and 45 (34%) slow early responders, and 16 (12%) undocumented. Two-year OS was 100% for low-risk, 93% for intermediate-risk, and 91% for high-risk patients. OS for HIV-negative (93%) and HIV-positive (89%) patients were similar (p = .53). Absolute lymphocyte count greater than 0.6 × 109 predicted survival (94% vs. 83%, p = .02).

In the first South African harmonised HL treatment protocol, risk stratification correlated with prognosis. Two-year OS of HIV-positive and HIV-negative patients improved since 2010, partially ascribed to standardised treatment and increased supportive care. This improved survival strengthens the harmonisation movement and gives hope that South Africa will achieve the WHO Global Initiative for Childhood Cancer goals.
Original languageEnglish
Article numbere30712
Number of pages11
JournalPediatric Blood & Cancer
Issue number1
Early online date9 Oct 2023
Publication statusPublished - 1 Jan 2024


  • Adolescent
  • Child
  • GICC
  • Harmonisation
  • Hodgkin lymphoma
  • South Africa


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