{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T19:34:44Z","timestamp":1785440084946,"version":"3.56.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T00:00:00Z","timestamp":1696809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Historic South African 5\u2010year overall survival (OS) rates for Hodgkin lymphoma (HL) from 2000 to 2010 were 46% and 84% for human immunodeficiency virus (HIV)\u2010positive and HIV\u2010negative children, respectively. We investigated whether a harmonised treatment protocol using risk stratification and response\u2010adapted therapy could increase the OS of childhood and adolescent HL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seventeen units prospectively enrolled patients less than 18\u00a0years, newly diagnosed with classical HL onto a risk\u2010stratified, response\u2010adapted treatment protocol from July 2016 to December 2022. Low\u2010 and intermediate\u2010risk patients received four and six courses of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), respectively. High\u2010risk 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\u2010positive patients could receive granulocyte colony\u2010stimulating factor and less intensive therapy if stratified as high risk, at the treating clinician's discretion. Kaplan\u2013Meier survival analysis was performed to determine 2\u2010year OS and Cox regression to elucidate prognostic factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort comprised 132 patients (19 HIV\u2010positive, 113 HIV\u2010negative), median age of 9.7\u00a0years, with a median follow\u2010up of 2.2\u00a0years. 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\u2010year OS was 100% for low\u2010risk, 93% for intermediate\u2010risk, and 91% for high\u2010risk patients. OS for HIV\u2010negative (93%) and HIV\u2010positive (89%) patients were similar (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.53). Absolute lymphocyte count greater than 0.6\u00a0\u00d7\u00a010<jats:sup>9<\/jats:sup> predicted survival (94% vs. 83%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the first South African harmonised HL treatment protocol, risk stratification correlated with prognosis. Two\u2010year OS of HIV\u2010positive and HIV\u2010negative 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.30712","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T02:39:52Z","timestamp":1697078392000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Improved survival of children and adolescents with classical Hodgkin lymphoma treated on a harmonised protocol in South Africa"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8792-3251","authenticated-orcid":false,"given":"Jennifer","family":"Geel","sequence":"first","affiliation":[{"name":"Pediatric Haematology\u2010Oncology University of the Witwatersrand Charlotte Maxeke Johannesburg Academic Hospital Wits Donald Gordon Medical Centre  Johannesburg South 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Service Faculty of Health Sciences University of Cape Town Red Cross War Memorial Children's Hospital  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6740-2376","authenticated-orcid":false,"given":"Yasmin","family":"Goga","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Haematology\u2010Oncology Service Faculty of Health Sciences University of Cape Town Red Cross War Memorial Children's Hospital  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2215-2264","authenticated-orcid":false,"given":"Amy","family":"Carr","sequence":"additional","affiliation":[{"name":"Pediatric Haematology\u2010Oncology University of KwaZulu\u2010Natal Durban Greys Hospital  Pietermaritzburg South 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