Immunotherapeutic strategies in children and adolescents with Hodgkin lymphoma.
● Principal Investigator: Dr Amita Mahajan
● To document the real-world data of the patterns of use and response of various immunotherapeutic agents in children and adolescents with HL in India.
● Children aged between 0-21 years who has received agents Brentuximab, Nivolumomab, Pembroluzimab from January 2018-December 2023.
● Also there full records and follow-up should be available.
● Full records and follow-up details unavailable.
● To document the real-world data of the patterns of use and response of various immunotherapeutic agents in children and adolescents with HL in India, specifically with regards to: clinical setting, doses used, observed responses and adverse events.
● To document the challenges in terms of response evaluation to these agents.
The outcomes of Hodgkin lymphoma in children and adolescents who receive optimal treatment approach in excess of 90% in patients with early stage disease and 80% in patients with advanced stage disease. Nevertheless, 10-20% patients either have refractory disease or have a recurrence. A significant proportion of them can be effectively salvaged with further chemotherapy/ immunotherapy including high dose chemotherapy with stem cell rescue.
The management of Hodgkin Lymphoma is currently undergoing a major paradigm shift with increasing role of immunotherapy especially for patients with relapsed/ refractory disease but also in frontline setting primarily with the specific purpose of improving outcomes with limited toxicity both in the short and long-term. The precise place of immunotherapy (anti CD30 monoclonal antibody and PDL1 blockade) in children is being defined in prospective collaborative studies by various consortia.
These novel agents, however, come at a considerable cost and our it is unclear whether there will be novel toxicities that may emerge with increasing cumulative experience. In low-middle-income countries, these modalities are largely reserved for relapsed/refractory disease frequently in off-label settings. For e.g., nivolumomab is currently licensed for post ASCT relapse but economic considerations mean that it may be used in pre-transplant settings as well to achieve response and allow for ASCT to be done. Experience at individual centers is limited. It is therefore, vital that we understand and collate real world data especially the response rates documented in various clinical settings and the adverse events observed as we work towards identifying optimal strategies in our settings for all patients.