Assessment of Drug Toxicity and Mortality in Children with Classical Hodgkin Lymphoma on ABVD/COPDAC Protocol – A Single Centre Study

Abstract

Objective: To assess the frequency of drug toxicity and mortality associated with ABVD/COPDAC protocol in children with classical Hodgkin Lymphoma at IHHN, Karachi.

Methodology: A prospective observational study was conducted over six months at the pediatric Oncology Unit of IHHN, Karachi, from April 2023 to September 2023, involving patients less than 16 years diagnosed with classical Hodgkin’s lymphoma and with normal cardiac function on echocardiography. The NCI Common Terminology Criteria for Adverse Events (CTCAE) was used to report toxicity and adverse effects. Toxicity was assessed over a total of eight chemotherapy cycles, and the total numbers of chemotherapy cycles assigned were based on the stage of the disease and the treatment group. Data was analyzed using SPSS version 26.

Results: 152 patients with Classical Hodgkin Lymphoma (mean age 9.45±3.43 years, male predominance 80.3%), toxicity was assessed over eight treatment cycles. In Cycle I, 5.9% had neutropenia, while 91.4% had no toxicity. In Cycle II, neutropenia was observed in 19.1%, with 76.3% reporting no toxicity. Cycle III showed 9.2% with neutropenia and 90.8% without toxicity, while Cycle IV recorded 12.5% with neutropenia and 83.6% without toxicity. Across Cycles V-VIII, neutropenia ranged from 5.3% to 14.5%, with 83.6% to 94.1% experiencing no toxicity. Cardiotoxicity and other severe toxicities were rare throughout all cycles. The overall mortality rate was low at 1.3%, with a 98.7% survival rate.

Conclusion: Study revealed varying levels of toxicity basis on treatment cycles and the overall mortality rate was low at 1.3%, with survival arte as 98.7%. Toxicity and mortality rates were statistically insignificant across the treatment groups, indicating that the ABVD/COPDAC protocol is generally safe and effective for this patient population.