{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T17:04:09Z","timestamp":1773680649159,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T00:00:00Z","timestamp":1729814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In children, nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is an uncommon subtype of Hodgkin lymphoma. Given the lack of data on the best chemotherapy regimen, there is a knowledge gap in best management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included all pediatric patients with NLPHL diagnosed and treated at the Children\u2019s Cancer Hospital, Egypt (2007\u20132018). We analyzed the clinical characteristics, and treatment outcome according to disease stage (early and advanced), treatment strategy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD] or rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone [R-CHOP] and explored the prognostic factors for progression-free survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age at diagnosis was 12 years; 40 (68%) patients had early-stage disease, and 19 (32%) had advanced-stage disease. The median follow-up was 70 months; the 5-year EFS and OS were 75% and 97%, respectively. The 5-year EFS was 78% for early-stage disease and 60% for advanced-stage disease; the 5-year OS was 100% for early-stage disease and 88% for advanced-stage disease. The patients who underwent R-CHOP had a better 3-year EFS (100%) compared with those who underwent ABVD (65%) regimen (P = 0.01). Seventeen (25%) patients relapsed: 9\/40 (22%) had early-stage disease, and 8\/19 (42%) had advanced-stage disease. Splenic involvement, mediastinal disease, extranodal disease, and slow early response were independent predictors of relapse risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pediatric patients with early-stage NLPHL have an excellent prognosis, with a 5-year OS of 100%. However, those with advanced stages had a high relapse rate. R-CHOP was associated with a better response and relapse-free rate than ABVD.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2024.1432650","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T05:11:19Z","timestamp":1729833079000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Exploring the complexity, treatment challenges, and outcomes in pediatric nodular lymphocyte predominant Hodgkin lymphoma: a perspective from a low\u2013middle-income country"],"prefix":"10.3389","volume":"14","author":[{"given":"Youssef","family":"Madney","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amr","family":"Abdalla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soha","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwa","family":"Romeih","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sally","family":"Fikry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Engy","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hala","family":"Taha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Zaghloul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eman","family":"Attia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-200205000-00010","article-title":"Lymphocyte-predominant hodgkin disease in children","volume":"24","author":"Sandoval","year":"2002","journal-title":"J Pediatr Hematol Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-200309000-00003","article-title":"Results of little or no treatment for lymphocyte-predominant Hodgkin disease in children and adolescents","volume":"25","author":"Murphy","year":"2003","journal-title":"J Pediatr Hematol Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.01.079","article-title":"Lymphocyte-predominant Hodgkin\u2019s lymphoma in children: Therapeutic abstention after initial lymph node resection - A study of the French Society of Pediatric Oncology","volume":"21","author":"Pellegrino","year":"2003","journal-title":"J Clin Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathol.2019.10.003","article-title":"Nodular lymphocyte predominant Hodgkin lymphoma: pathology, clinical course and relation to T-cell\/histiocyte rich large B-cell lymphoma","volume":"52","author":"Hartmann","year":"2020","journal-title":"Pathology"},{"key":"B5","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1111\/bjh.15616","article-title":"Modern principles in the management of nodular lymphocyte-predominant Hodgkin lymphoma","volume":"184","author":"Spinner","year":"2019","journal-title":"Br J Haematol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12055","article-title":"Nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents - a comprehensive review of biology, clinical course and treatment options","volume":"159","author":"Shankar","year":"2012","journal-title":"Br J Haematol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/pbc.27288","article-title":"Unfavorable presentation but comparable outcome: Presentation and outcome of children with nodular lymphocyte predominant Hodgkin lymphoma from India","volume":"65","author":"Prasad","year":"2018","journal-title":"Pediatr Blood Cancer"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1080\/1042819031000149421","article-title":"Diffuse large B-cell lymphoma arising in nodular lymphocyte predominant hodgkin lymphoma: a report of 21 cases from the nebraska lymphoma study group","volume":"45","author":"Huang","year":"2004","journal-title":"Leuk Lymphoma"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/pbc.27375","article-title":"Outcomes in intermediate-risk pediatric lymphocyte-predominant Hodgkin lymphoma: A report from the Children\u2019s Oncology Group","volume":"65","author":"Marks","year":"2018","journal-title":"Pediatr Blood Cancer"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-12-541078","article-title":"Advanced-stage nodular lymphocyte predominant Hodgkin lymphoma compared with classical Hodgkin lymphoma: a matched pair outcome analysis","volume":"123","author":"Xing","year":"2014","journal-title":"Blood"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-06-361055","article-title":"Phase 2 study of rituximab in newly diagnosed stage IA nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group","volume":"118","author":"Eichenauer","year":"2011","journal-title":"Blood"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.53.2069","article-title":"Mature results of a phase II study of rituximab therapy for nodular lymphocyte\u2013predominant hodgkin lymphoma","volume":"32","author":"Advani","year":"2014","journal-title":"J Clin Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2007.06736.x","article-title":"Outcome of children with nodular lymphocyte predominant Hodgkin lymphoma - a Children\u2019s Cancer and Leukaemia Group report","volume":"138","author":"Hall","year":"2007","journal-title":"Br J Haematol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.65.3469","article-title":"Minimal treatment of low-risk, pediatric lymphocyte-predominant hodgkin lymphoma: A report from the children\u2019s oncology group","volume":"34","author":"Appel","year":"2016","journal-title":"J Clin Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14518","article-title":"Advanced stage nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents: clinical characteristics and treatment outcome - a report from the SFCE & CCLG groups","volume":"177","author":"Shankar","year":"2017","journal-title":"Br J Haematol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1989.7.11.1630","article-title":"Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin\u2019s disease: Cotswolds meeting","volume":"7","author":"Lister","year":"1989","journal-title":"J Clin Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.54.8800","article-title":"Recommendations for initial evaluation, staging, and response assessment of hodgkin and non-hodgkin lymphoma: The lugano classification","volume":"32","author":"Cheson","year":"2014","journal-title":"J Clin Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13540","article-title":"Childhood and Adolescent nodular lymphocyte predominant Hodgkin lymphoma - A review of clinical outcome based on the histological variants","volume":"171","author":"Shankar","year":"2015","journal-title":"Br J Haematol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22762","article-title":"Resection alone in 58 children with limited stage, lymphocyte-predominant Hodgkin lymphoma\u2013experience from the European network group on pediatric Hodgkin lymphoma","volume":"110","author":"Mauz-K\u00f6rholz","year":"2007","journal-title":"Cancer"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13979","article-title":"Relapsed or poorly responsive nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents - a report from the United Kingdom\u2019s Children\u2019s Cancer and Leukaemia Study Group","volume":"173","author":"Shankar","year":"2016","journal-title":"Br J Haematol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/hon.782","article-title":"Different histopathological subtypes of Hodgkin lymphoma show significantly different levels of FDG uptake","volume":"24","author":"Hutchings","year":"2006","journal-title":"Hematol Oncol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-02-766121","article-title":"Encouraging activity for R-CHOP in advanced stage nodular lymphocyte\u2013predominant Hodgkin lymphoma","volume":"130","author":"Fanale","year":"2017","journal-title":"Blood"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18169","article-title":"Management of children and adults with all stages of nodular lymphocyte predominant Hodgkin lymphoma: A consensus-based position paper from the Hodgkin lymphoma subgroup of the National Cancer Research Ins","volume":"197","author":"Shankar","year":"2022","journal-title":"Br J Haematol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"29872993","DOI":"10.1182\/blood.2019004044","article-title":"How I treat nodular lymphocyte predominant Hodgkinlymphoma","volume":"136","author":"Eichenauer","year":"2020","journal-title":"Blood"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30647","article-title":"Variant histology of pediatric nodular lymphocyte-predominant Hodgkin lymphoma with IgD and CD30 expression","volume":"70","author":"Ali","year":"2023","journal-title":"Pediatr Blood Cancer"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1997 2000","DOI":"10.1080\/10428194.2022.2053533","article-title":"Practice patterns for the management of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL): an international survey by the Global NLPHL One Working Group (GLOW)","volume":"63","author":"Lo","year":"2022","journal-title":"Leukemia Lymphoma"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1432650\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T05:11:21Z","timestamp":1729833081000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1432650\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,25]]},"references-count":26,"alternative-id":["10.3389\/fonc.2024.1432650"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2024.1432650","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,25]]},"article-number":"1432650"}}