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Background: Pediatric classical Hodgkin lymphoma (CHL) is a curable disease; however, the optimal salvage regimen is unclear for relapsed/refractory (R/R) disease. This study aimed to compare response rates, toxicity, event-free survival (EFS), and overall survival (OS) of ifosfamide, carboplatin, and etoposide (ICE) with gemcitabine and vinorelbine (GV) regimen after first-line doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) in pediatric patients with R/R CHL. Methods: This is a retrospective cohort study of 132 pediatric patients with R/R CHL treated from July 2012 to December 2020 with ICE (n = 82) or GV (n = 50). Results: The median age at relapse was 13.9 years, and 68.2% were men. Rates of complete response, partial response, and progressive di sease before consolidation were 50.6%, 3.7%, and 45.7% for ICE and 28.5%, 0%, and 71.5% for GV (P = 0.011). By multivariate analysis, regimen (P = 0.002), time to relapse (P = 0.0001), and B-symptoms (P = 0.002) were independent factors to lower response rates. Hematological toxicity, electrolyte disturbance, hemorrhagic cystitis, infectious complications, and hospital admission for fever neutropenia were statistically significant higher for the ICE regimen. Treatmentrelated mortalities were 2.4% for ICE and 2% for GV (P = 0.86). The 3-year EFS was 39.3% ± 11.4% for ICE and 24.9% ± 12.5% for GV (P = 0.0001), while 3-year OS was 69.3% ± 10.6% and 74% ± 12.9% (P = 0.3), respectively. By multivariate analysis, regimen (P = 0.0001), time to relapse (P = 0.011), B-symptoms (P = 0.001), and leukocytosis (P = 0.007) were significant for EFS, while anemia (P = 0.008), and progressive disease on early response evaluation (P = 0.022) were significant for OS. Conclusions: The ICE regimen had a better overall response rate and EFS, but higher toxicity, than GV; however, OS and mortality were similar. [ABSTRACT FROM AUTHOR]

Background: Many studies on recurrent disc herniation exist, however only mixed patient populations have been analyzed. Recurrent herniation following disc excision has been reported in 5-11% of patients. Objectives: To analyze the factors that influenced the outcomes of repeat discectomy through a retrospective evaluation of 31 patients with recurrent lumbar disc herniation. Methods: Recurrent lumbar disc herniation is considered when an ipsilateral or contralateral disc herniation at the same level happens, with a pain-free interval more than 6 months. MRI with contrast was done and revision surgery was performed in all patients using conventional open discectomy. Results: The mean pain-free interval was 31 months. During the revision surgery the disc pathology was of the contained type in 8 patients and the noncontained type in 23 patients. Epidural fibrosis was seen in 29 patients. All patients had follow-up of at least 1 year. At the final follow-up, their average JOA score was 24, with the average recovery rate of 72%. There were no demonstrated effects from age, sex, traumatic events, level of herniation, procedures of revision surgery, or dural tear on the recovery rate. However a negative impact on the recovery rate was found related to the following factors: times of prior surgery, side of recurrence, pain-free interval, duration of recurrence symptoms, associated spinal stenosis. Conclusion: A revision surgery for recurrent lumbar disc herniation showed satisfactory results that were comparable with those of primary discectomy, therefore a repeat discectomy can be recommended for the management of recurrent lumbar disc herniation. [ABSTRACT FROM AUTHOR]