Retrospective Iranian cohort links younger age and elevated ESR to relapse in pediatric Hodgkin lymphoma

Treatment failure occurred in 24 of 83 children with Hodgkin lymphoma in a retrospective Iranian cohort, according to the study’s published abstract, with 14 patients relapsing after complete remission, 11 experiencing primary refractory disease and one classified as having both conditions. Continuous complete remission was achieved in 58 patients, or 69.8% of the cohort.

The study included patients diagnosed with pediatric Hodgkin lymphoma at a tertiary referral center in Iran from 2014 through 2024. Eligible participants had baseline positron emission tomography/computed tomography staging and complete outcome data; three additional patients without baseline staging were excluded. The analysis covered demographic, clinical, histopathological, laboratory, treatment and outcome information extracted from medical records. Treatment failure was defined as relapse following complete remission or primary refractory disease. Associations with failure were examined using univariate analyses, rather than a multivariable predictive model.

The cohort included 54 males, or 65.1%, and 29 females, or 34.9%), and the mean age at diagnosis was 10.72 ± 3.86 years. Stage III disease was the predominant presentation, accounting for 66.3% of patients. Younger age at diagnosis was associated with relapse: relapsing patients had a mean age of 8.29 ± 3.73 years, compared with 11.22 ± 3.72 years among those who did not relapse (p = 0.015). Elevated erythrocyte sedimentation rate, defined as ESR above 50 mm/hr, was also associated with relapse, occurring in 42.9% of relapsing patients and 11.6% of patients without relapse (p = 0.010).

Fever and night sweats at diagnosis were associated with primary refractory disease. Fever was present in 45.5% of patients with refractory disease, compared with 8.3% of those without it (p = 0.005), while night sweats were present in 36.4% and 8.3%, respectively (p = 0.024). Histological subtype, whether classical Hodgkin lymphoma or nodular lymphocyte-predominant Hodgkin lymphoma, disease stage and the first-line chemotherapy regimen were not significantly associated with treatment failure. Among patients who experienced failure, ESHAP was the most frequently used salvage regimen, while 14 patients, or 16.9% of the full cohort, received brentuximab vedotin or nivolumab.

The findings are limited by the retrospective design, small single-center population, exclusion of three patients without baseline PET/CT staging and use of univariate associations. The results therefore identify features associated with relapse or refractory disease in this cohort but do not establish independent predictors or demonstrate that the reported factors caused treatment failure. The authors called for larger prospective studies to assess whether these associations can support risk stratification and inform treatment strategies.

Subject of Research: Factors associated with relapse and primary refractory disease in a retrospective cohort of 83 children with Hodgkin lymphoma in Iran

Article Title: Treatment failure and associated factors in pediatric Hodgkin lymphoma: a decade of institutional experience from a middle-income country

Article References: Farokhmanesh, S., Ghanbari, P., Karimzadeh, A., Zekavat, O. R., Bordbar, M., Shahriari, M., Zareifar, S., & Mottaghipisheh, H. (2026). Treatment failure and associated factors in pediatric Hodgkin lymphoma: a decade of institutional experience from a middle-income country. BMC Cancer. https://doi.org/10.1186/s12885-026-17031-w

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17031-w

Keywords: pediatric Hodgkin lymphoma, treatment failure, relapse, primary refractory disease, retrospective cohort, Iran, prognostic factors, PET/CT staging, salvage therapy, Treatment, failure, associated