Youssef Madney ^1,2* Amr Abdallah ^1,3 Soha Ahmed ⁴ Marwa Romeih ⁵ Sally Fikry ⁶ Engy Mohammed ⁷ Hala Taha ⁸ Mohamed Zaghloul ⁹ Eman Attia ³

• ¹ National Cancer Institute, Cairo University, Cairo, Egypt
• ² Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt, Egypt, Cairo, Egypt
• ³ Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
• ⁴ Clinical Oncology and Nuclear Medicine Department, Suez University, Egypt, cairo, Egypt
• ⁵ Radiodiagnosis Department, Faculty of Medicine, Helwan University and Children’s Cancer Hospital Egypt, Egypt, cairo, Egypt
• ⁶ Clinical Pharmacy Department, Children’s Cancer Hospital Egypt, Egypt, cairo, Egypt
• ⁷ Clinical Research Department, Children’s Cancer Hospital Egypt, Egypt, cairo, Egypt
• ⁸ Surgical Pathology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt, Egypt, Cairo, Egypt
• ⁹ Radiation Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt, Egypt, cairo, Egypt

Background: 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. Methods: This retrospective study included all pediatric patients with NLPHL diagnosed and treated at the Children's Cancer Hospital, Egypt (2007-2018).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. Results: 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 advancedstage disease. Splenic involvement, mediastinal disease, extranodal disease, and slow early response were independent predictors of relapse risk. Conclusion: 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.