{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T01:21:44Z","timestamp":1792718504735,"version":"4.5.0"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,11,23]],"date-time":"2016-11-23T00:00:00Z","timestamp":1479859200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pediatric patients with non\u2010Hodgkin lymphoma (NHL) in developing countries (DCs) present with greater tumor load even at lower stages and with comorbidities that impact therapy delivery. This causes toxic mortality with \u201cstandard\u201d intensive protocols or recurrences with \u201cgentler\u201d treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We developed and evaluated a risk stratification schema that guides intensity of therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design\/Methods<\/jats:title><jats:p>Sixty\u2010nine patients were prospectively assigned to five risk groups (A\u2013E; n = 6, 15, 16, 15, and 17) following staging and treated with protocols of risk\u2010stratified intensity. Risk stratification utilized St. Jude stage, disease bulk, and sites involved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2006 and 2011, 69 patients with B\u2010cell NHL were enrolled. Among these, 72.5% were boys with mean age of 6.9 years (\u00b13.33 [SD]; range 2.4\u201314.2 years). Eighty\u2010seven percent had Burkitt lymphoma, 82.6% had advanced stage (25 [36.2%] stage III; 32 [46.4%] stage IV), and 24.6% were central nervous system positive. Mean lactate dehydrogenase increased progressively across the risk strata. Among these, 0\/6, 1\/15, 3\/16, 2\/15, and 7\/17 patients relapsed\/progressed within each risk stratum. Fifteen patients died; three from treatment\u2010related toxicity. At a median follow\u2010up of 6.2 years, the overall and event\u2010free survival (EFS) for all patients was 78.1 and 75.4%, respectively; EFS was related to risk assignment. The frequency of documented infectious and noninfectious toxicities increased with higher risk group assignment causing prolongation of admissions and potential treatment delays.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Reduction in treatment intensity for an identified subset of patients with NHL is feasible, while high\u2010intensity therapy is required for high\u2010risk groups. This risk stratification system may be a first step toward improving the outcomes in some DCs.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.26335","type":"journal-article","created":{"date-parts":[[2016,11,23]],"date-time":"2016-11-23T05:06:49Z","timestamp":1479877609000},"source":"Crossref","is-referenced-by-count":11,"title":["Risk\u2010adapted stratification for optimally intensive treatment assignment of pediatric patients with non\u2010Hodgkin lymphoma is an effective strategy in developing countries"],"prefix":"10.1002","volume":"64","author":[{"given":"Asim F.","family":"Belgaumi","sequence":"first","affiliation":[{"name":"Department of Pediatric Hematology\/Oncology King Faisal Specialist Hospital &amp; Research Center  Riyadh Saudi Arabia"},{"name":"Sidra Medical and Research Center  Doha Qatar"},{"name":"Weill Cornell Medical College\u2014Qatar Cornell University  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Anas","sequence":"additional","affiliation":[{"name":"Division of Nursing, King Fahd National Center for Children's Cancer King Faisal Specialist Hospital &amp; Research Center  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khawar S.","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology\/Oncology King Faisal Specialist Hospital &amp; Research Center  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed F.","family":"Akhter","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology\/Oncology King Faisal Specialist Hospital &amp; Research Center  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amani","family":"Al\u2010Kofide","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology\/Oncology King Faisal Specialist Hospital &amp; Research Center  Riyadh Saudi Arabia"},{"name":"College of Medicine Al\u2010Faisal University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,11,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.33.3369"},{"issue":"1","key":"e_1_2_7_3_1","first-page":"S87","article-title":"Non\u2010Hodgkin lymphoma in children and adolescents","volume":"225","author":"Reiter A.","year":"2013","journal-title":"Klin Padiatr"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-07-036665"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1807-59322010001200008"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e3181bdf1f3"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21046"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22905"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-7563.2009.01264.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21452"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20458"},{"key":"e_1_2_7_12_1","first-page":"332","article-title":"Classification, staging and end results of treatment of childhood non\u2010Hodgkin's lymphomas: dissimilarities from lymphomas in adults","volume":"7","author":"Murphy SB","year":"1980","journal-title":"Semin Oncol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V97.11.3370"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2008.07144.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-03-0973"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1578"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.1999.01064.x"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13312-010-0172-5"}],"container-title":["Pediatric Blood &amp; 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