Empirical Anti-tubercular Treatment given to children with Hodgkin Lymphoma: does it impact outcomes?

Abstract

Background/ Objectives: Hodgkin lymphoma in children presents with lymphadenopathy and may be confused with tuberculosis in regions with high prevalence of this infection. The extent of this misdiagnosis and its impact has not been describedpreviously.This study looks at the prevalence of administration of Anti-Tubercular Treatment (ATT) prior to being diagnosed with Hodgkin Lymphoma(HL)and its impact on clinical profile and outcomes in InPOG-HL-15-01. Design/Methods: InPOG-HL-15-01 was a prospective study for newly diagnosed patients with HL. Treatment with ATT prior to diagnosis, clinical profile and outcomes were documented. 396 patients were recruited from 23 centres over 30 months.Clinical profile and early outcome of patients who received ATT and those who did not in the months preceding the diagnosisof HL were compared. Results: At diagnosis 115/ 396(29%) patients had received ATT. The median age and gender distribution of those who received and did not receive ATT was not statistically different.Thosereceiving ATT were more likely to have advanced diseasei.e. StagesIIB/III/IV (59%vs36%, p<0.001)and B symptoms (69% vs. 43%, p<0.001). The incidence of bulkydisease was similar in the two groups. At a median follow up of 30 months from diagnosis, this cohort hashas inferior event free survivaland overall survival (p=0.01). Conclusions: Empirical ATT continues to be common practice in India. Receiving ATT prior to diagnosis of HL was associated with advanced disease and B symptoms but not bulky disease. It was also associated with inferior outcomes. The practice of empirical ATT should be actively discouraged.