Abstract
Objective
To evaluate the proportion of patients who received empirical treatment with antitubercular therapy (ATT) prior to the diagnosis of Hodgkin lymphoma (HL) in the first multicentric, prospective study on HL from India, and to assess its impact on extent of disease at diagnosis and outcomes.
Methods
Children < 18 y with biopsy proven HL were enrolled in InPOG-HL-15-01. Along with other clinical and epidemiological data, history of prior treatment with ATT was documented. All patients received treatment as per a risk-stratified, response-adapted strategy.
Results
Out of 396, 115 (29%) children had received ATT prior to establishing a definitive diagnosis of HL. This cohort presented with advanced-stage disease (p = 0.001) and B symptoms (p = 0.001) in a higher proportion of cases. Consequently, those children were more likely to receive 6 rather than 4 cycles of chemotherapy (p = 0.001). They were more likely to have infradiaphragmatic involvement (p = 0.001). Overall survival and event-free survival were not different.
Conclusion
Empirical treatment with ATT in children presenting with lymphadenopathy continues to be practiced widely in India. The delay in diagnosis may contribute to children presenting with advanced-stage disease warranting more intensive treatment for successful outcomes.
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Acknowledgements
The authors acknowledge the contribution made by Krishnakumar Rathnam (Meenakshi Mission Hospital, Madurai, Tamil Nadu), Arun Sheshachalam (GVN Hospital Trichy, Tamil Nadu), Shailesh Kanvinde (Dinanath Mangeshkar Hospital, Maharashtra), Jayanthi Srirambathala (MNJ Hospital, Telangana), Soma De (SGCC & RI Hospital, West Bengal), Sirisha Rani (Rainbow Children Hospital, Hyderabad, Telangana), Biswajit Dubashi (JIPMER Hospital, Puducherry), Anupama Borker (Goa Medical College, Maharashtra), Pritanjali (AIIMS, Patna, Bihar), Nandini Hazarika (Rainbow Hospital, Delhi), Sanjeev Digra (GMC, Jammu), Praveen Sobti (CMC, Ludhiana, Punjab), Vineeta Gupta (BHU, Varanasi, Uttar Pradesh), Sunil Bhat (MSCC Bangalore), Hari Shankaran (Amrita Institute, Kochi), Priya Kumari (RCC, Trivandrum), Deepa Trivedi (Hematology-Oncology Clinic, Gujarat) and CanKids.
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AM, SJ, RSA, VD, MK, JC: Conception and design, patient acquisition, and data analysis & interpretation; SB, M Singh, RS, NV, VR, PM, GK, M Sajid, RK, SM: Patient acquisition; AT: Data analysis & interpretation. JC will act as the guarantor for this paper.
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Mahajan, A., Bakhshi, S., Singh, M. et al. Empirical Antitubercular Treatment for Lymphadenopathy: Are We Missing Lymphoma?. Indian J Pediatr 90, 761–765 (2023). https://doi.org/10.1007/s12098-022-04180-6
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DOI: https://doi.org/10.1007/s12098-022-04180-6