Exploring the Outcomes of Hodgkin Lymphoma in Pediatric Patients: A Systematic Review from India

Hodgkin lymphoma (HL) has emerged as one of the most curable pediatric cancers globally. However, in low- and middle-income countries like India, the treatment landscape is shaped by various biological, social, and resource-related factors, leading to variability in management approaches and outcomes. This systematic review aims to bring together the available data to provide an integrated overview of current management practices and outcome of childhood HL in India. Thirteen studies were reviewed, including 3 multicenter studies, with a total cohort of 1,766 children. The median age at diagnosis ranged from 7 to 10 years, with male-to-female ratios between 2.8:1 and 10.5:1. A significant proportion (70–80%) of children presented with advanced stages of the disease. Utilization of positron emission tomography-computed tomography for assessment was inconsistent across centers, and the use of radiotherapy (RT) varied widely. Most centers have reported 5-year overall survival and 5-year event-free survival of approximately 90% and above and 75 to 85%, respectively. Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) was the most widely used regimen; however, recent studies have used vincristine, etoposide, prednisolone, doxorubicin (OEPA)/cyclophosphamide, vincristine, prednisolone, dacarbazine (COPDAC) with the intent to reduce long-term side effects associated with radiation exposure. Treatment-related mortality of around 5% was noted with OEPA/COPDAC in Indian setting in contrast to ABVD, which is close to 1%. Feasibility and long-term benefits of the former chemotherapy need further follow-up. Challenges such as treatment abandonment and toxic deaths remain significant, and there is a notable lack of data on long-term outcomes and late effects, necessitating further research in these areas.