\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}



\usepackage{float}








\begin{document}

\title{Survival of pediatric Hodgkin lymphoma patients treated with
doxorubicin, bleomycin, vincristine, etoposide, prednisone, and
cyclophosphamide (ABVE-PC) versus Adriamycin, bleomycin, vinblastine,
and dacarbazine (ABVD) at a single institution}



\author[1]{Sebastian de Armas}%
\author[2]{Carolina Huertas-Ayala}%
\author[3]{Randall Chan}%
\author[4]{Yueh-Yun Chi}%
\author[5]{Winston Huh}%
\author[6]{Amanda Termuhlen}%
\author[7]{Paul Gaynon}%
\author[8]{Andrew Doan}%
\affil[1]{Loma Linda University School of Medicine}%
\affil[2]{San Juan Bautista School of Medicine}%
\affil[3]{Keck School of Medicine of the University of Southern California}%
\affil[4]{USC Keck School of Medicine}%
\affil[5]{Children's Hospital Los Angeles Department of Pediatrics}%
\affil[6]{University of Minnesota System}%
\affil[7]{University of Southern California}%
\affil[8]{Children's Hospital of Los Angeles}%


\vspace{-1em}



  
  \date{May 24, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Background: ABVD, the standard-of-care in adult Hodgkin lymphoma (HL),
has not been directly compared to ABVE-PC, a pediatric regimen designed
to reduce late-effects. We aimed to compare the effectiveness and
associated toxicities of these two regimens used in the same
institution. Methods: This retrospective cohort study evaluated a total
of 224 patients diagnosed with HL between 1999 and 2018 at Children's
Hospital Los Angeles (CHLA), of which 93 patients were eligible having
received ABVD (n=46) or ABVE-PC (n=47) chemotherapy as their initial
treatment. Descriptive analyses were performed using the Student's
t-test or Fisher's exact test. Survival analysis used the Kaplan-Meier
method. Events included: death, relapse, secondary malignancy, need for
radiation therapy, pulmonary toxicity and cardiomyopathy determined by
shortening fraction \textless{}29\%. Analyses followed an
intention-to-treat principle. Results: There was no difference in
baseline characteristics between the patients receiving ABVE-PC or ABVD
in regard for stage, risk group or prognostic variables, such as the
presence or absence of ``B'' symptoms, bulky disease, and extra-nodal
involvement. A greater proportion of patients treated with ABVE-PC
received consolidating external beam radiation treatment (XRT) either by
randomization or by response compared to ABVD (59.6\% vs 32.6\%
respectively, p=0.01). While not statistically significant, response to
therapy, assessed by PET/CT where available, mirrored the need for
radiation (rapid response 58.3\% vs 90.0\%, n=34, p=0.11). There was no
difference in event-free survival (p=0.63) or overall survival (p=0.37)
with a median follow up length of 3.9 years. Conclusion: ABVD and
ABVE-PC achieved similar survival outcomes in our single-institution
cohort%
\end{abstract}%



\sloppy


\textbf{Introduction}

Hodgkin Lymphoma (HL) in children is treated via a number of separate
protocols in the low, intermediate and high risk
stratums.\textsuperscript{1,2} In adults with HL however, ABVD has been
considered the de-facto standard of care for several decades due to its
effectiveness and excellent toxicity profile.\textsuperscript{3,4} Late
effects including cardiotoxicity and reduced fertility remain a concern
although overall the late effects profile is
favorable.\textsuperscript{5--7} There is also evidence that
radiotherapy can be eliminated in the low risk stratum, which is an
attractive approach to reduce risk of organ toxicities and secondary
malignancies.\textsuperscript{8}

In the pediatric patient population, ABVE-PC, a dose-dense regimen has
been more commonly used, especially in trials conducted by the
Children's Oncology Group (COG). \textsuperscript{1,2,9} ABVE-PC therapy
is often risk-adapted and based on interim disease
response.\textsuperscript{9,10} Given the ability of children to
tolerate more short-term toxicities, ABVE-PC is able to reduce exposure
to anthracyclines and alkylators.\textsuperscript{9} The COG study
AHOD0031 has also shown that external beam radiation treatment (XRT) can
be safely eliminated in patients with interim rapid early response
.\textsuperscript{9}

An abstract presented findings comparing AYA patients in two different
clinical trials, and the results suggest that AYA patients do worse on
adult protocols (ABVD vs Stanford V) when compared to pediatric protocol
(ABVE-PC), with worse failure-free survival (FFS) and overall survival
(OS).\textsuperscript{11} We conducted a study to directly compare the
efficacy and toxicity of ABVD to ABVE-PC for patients with HL within
different disease risk strata. We hypothesized that ABVE-PC has a
similar outcome as measured by EFS and OS when compared to ABVD in
pediatric patients with newly diagnosed HL at our institution.

\textbf{Methods}

This retrospective cohort study evaluated pediatrics patients diagnosed
with HL, ages 4-20 years old at diagnosis, between 1999 and 2018 at
Children's Hospital Los Angeles (CHLA). Patients were identified by
reviewing an already-existing database of patients maintained for the
purposes of providing direct patient care. All patients who received
ABVD and/or ABVE-PC as initial treatment for newly diagnosed HL were
included. Patients were excluded due to either receiving a different
therapy (\emph{e.g.} bleomycin, etoposide, doxorubicin,
cyclophosphamide, vincristine, procarbazine and prednisone \{BEACOPP\}),
incomplete therapy, receiving therapy at an outside institution of CHLA
with incomplete data including pathology reports, treatment
documentation and disease response evaluations.

Demographic information collected included: age at diagnosis as well as
self-reported gender, race, and ethnicity. Prognostic variables
abstracted from the medical record included Ann Arbor staging, presence
of B-symptoms (unexplained weight loss \textgreater{} 10\% in the
preceding 6 months, unexplained recurrent fever [?] 38\selectlanguage{ngerman}°C in the preceding
month or recurrent drenching sweats in the preceding month), presence of
splenic involvement, presence of extra-nodal disease, erythrocyte
sedimentation rate at diagnosis, peripheral blood leukocyte count at
diagnosis, and hemoglobin concentration at diagnosis. All chemotherapy
regimens, including changes and deviations, were recorded. Results of
positron emission tomography/computed tomography (PET/CT) were recorded
where available. Total anthracycline doses were recorded in
doxorubicin-equivalent units and reported as mg/m\textsuperscript{2}.
Echocardiogram and pulmonary function testing results were recorded
where available. OS was defined as the time from diagnosis to death of
any cause. EFS was defined as the time from diagnosis to death,
relapse/progression of disease, or diagnosis of a secondary malignancy.

Descriptive analyses were performed using the Student's t-test or
Fisher's exact test for continuous or dichotomous variables,
respectively. Survival analysis was performed using the Kaplan-Meier
life table method. All analyses followed an intention-to-treat
principle, guided by the initial therapy chosen. Late effects were
analyzed and including secondary malignancy, pulmonary toxicity and
cardiomyopathy determined by shortening fraction \textless{}29\%. We
assessed treatment response from the available radiology reports, which
included CT and PET/CT. Disease response was assessed by change in
maximum SUV, change in the size of lymph nodes, and, if available, the
Deauville score. All analyses were carried out on the R Project for
Statistical Computing version 3.

All study protocols were carried out under supervision of the IRB and in
compliance with the Declaration of Helsinki.

\textbf{Results}

224 patients with HL were screened for inclusion. Of the total charts
examined 93 patients were found to be eligible; 46 patients had received
ABVD and 47 patients had received ABVE-PC chemotherapy as initial
chemotherapy. 129 patients were not included due to either receiving
either a different therapy or a variation of the two therapies in
question, and 2 patients were excluded due to having received initial
therapy at a different institution. There were no significant
differences in the two groups regarding gender, ethnicity, and race
(Table 1). Of note, the ABVE-PC group contained statistically
significantly older patients on average compared to the ABVD group (14.5
vs 12.7 years, \emph{p} =0.03).

Known prognostic factors are summarized in Table 2. As risk
classification has changed multiple times during the time period
examined, patients were stratified retrospectively and uniformly into
comparable risk groups utilizing the criteria employed by the COG
AHOD0031 study.\textsuperscript{9} There were no statistically
significant differences found in risk stratification (Table 2,\emph{p}
=0.56). There were also no differences in splenic involvement,
extra-nodal extension, erythrocyte sedimentation rate, leukocyte count,
or hemoglobin concentration.

Patients were followed for a median of 3.9 years from diagnosis (range
0.3-18.1 years, interquartile range 1.5-5.8 years). There was no
difference found in EFS and OS between patients who received ABVE-PC and
those who received ABVD (Figures 1A and 1B, \emph{p} =0.46 and\emph{p}
=0.37, respectively). There was no difference in the proportion of
patients requiring more than four cycles of chemotherapy or requiring a
chemotherapy regimen change (Table 3). Notably, more patients in the
ABVE-PC group received external beam radiation when compared to the ABVD
group in intention-to-treat analysis (59.6\% vs 32.6\%, Table 3,\emph{p}
=0.01), although 6 patients achieved complete response but were
randomized to receive radiation on the AHOD0031 study. When the 6
patients were analyzed as not having radiation, the difference was not
statistically significant (46.8\% vs 32.6\%, Table 3, \emph{p} =0.21).
Response by PET-CT was only available for a subset of the cohort
(\emph{n} =34). 90\% of patients receiving ABVD (\emph{n} =9 of 10
total) and 58.3\% of patients receiving ABVE-PC (\emph{n} =14 of 24
total) had rapidly-responsive lesions on PET-CT following 2 cycles of
therapy (\emph{i.e.,} Deauville score of 1, 2, or 3) (\emph{p} =0.11).

Late effects are summarized in Table 4; statistics are not available due
to extremely low event rates. There were no apparent differences seen in
reduced cardiac shortening fractions (SF, reduced SF defined as
\textless{}29\%), reduced diffusing capacity of the lung for carbon
monoxide (DLCO), second malignancies or evidence of early gonadal
dysfunction (as measured by follicle stimulating hormone above
gender-defined norms).

\textbf{Discussion}

In this study, we aimed to compare two chemotherapy regimens commonly
utilized at our institution for pediatric HL in regard to efficacy and
toxicity. We found that there was no significant difference in EFS
(p=0.46) or OS (p=0.37), with a median follow up length of 3.9 years.
Our results corroborate prior published literature concerning the high
overall success rate of both medication regimens and allow for direct
comparison between the two regimens.\textsuperscript{8,9}

Since treatment for HL is uniformly effective, the main challenge in
developing pediatric clinical trials is to develop strategies to
maintain OS while avoiding or reducing long-term morbidity. ABVE-PC, a
pediatric regimen specifically designed to reduce late-effects in
comparison to regimens developed in adult populations, was examined in
the Children's Oncology Group AHOD0031 trial in an effort to eliminate
radiation for a subset of patients. The 10-year follow up for the
AHOD0031 trial found excellent outcomes for rapid early responders, and
radiation therapy did not provide significant benefit in EFS over 10
years (RT 83.8\% vs no RT 82.5\%, p=0.26).\textsuperscript{12} Since
completion of the AHOD0031 trial however, several case series have shown
that ABVD without radiation is feasible and associated with excellent
outcomes in children with complete metabolic response on PET/CT imaging
after chemotherapy.\textsuperscript{13,14} When directly comparing the
two regimens in similar populations, we found in our cohort that a
greater proportion of patients treated with ABVE-PC received
consolidating external beam radiation treatment (XRT) compared to ABVD
in intention-to-treat analysis, but the difference was no longer
statistically significant when patients randomized to radiation were
instead analyzed as not having received radiation. Response by PET,
where available, mirrored the need for radiation although the numbers
available were limited.

Ultimately the goal of risk-adapted therapy, selective elimination of
radiotherapy and overall reduction in therapeutic intensity is to reduce
the risk of late effects and subsequent malignant
neoplasms.\textsuperscript{15} Numerous late effects such as
hyper/hypothyroidism, thyroid nodules, heart disease, pulmonary
fibrosis/pneumonitis, skin cancer in radiation field, chronic fatigue,
perceived cognitive change, peripheral neuropathy, sexual changes, and
osteoporosis have been described following therapy for pediatric
HL.\textsuperscript{16} Subsequent malignant neoplasms are also seen, as
noted in for example in the long-term results of AHOD0031 where study
authors found an excess absolute risk of 1.2 malignant neoplasms / 1000
person-years.\textsuperscript{12} Reductions in therapy intensity have
been shown to reduce the rate of late complications as
well.\textsuperscript{17} No apparent differences were seen in our
cohort in regards to commonly-screened late effects or subsequent
malignant neoplasms, although the low event rate for both regimens
precluded analysis.

It is notable that most patients identified as Hispanic ethnicity, an
expected finding that reflects the population our hospital serves as the
primary free-standing children's hospital in Los Angeles and as part of
the safety net for vulnerable populations. Several large studies using
have shown that patients identifying with Hispanic ethnicity have had
poorer survival with HL. Kahn et al found that Hispanic patients with
pediatric HL had a higher risk of post-relapse mortality from pooled
clinical trial data (including patients from the AHOD0031); however Kahn
et al also found no difference in outcomes overall for Hispanic patients
with pediatric HL when analyzing the Surveillance, Epidemiology, and End
Results program in the United States.\textsuperscript{18,19} Grubb et al
found that Hispanic males had inferior disease specific
survival.\textsuperscript{20} Interestingly, the results of our study
indicate overall excellent outcomes for Hispanic patients that reflect
the general population with respect to EFS and OS are possible, although
our numbers are small as a single institution.

There are several limitations to our study. Primarily, as this was not a
clinical trial and chemotherapy regimens were chosen individually,
subtle selection biases may have been introduced along with variations
in number of chemotherapy courses and decisions regarding the use of
radiotherapy. Second, despite collecting all the HL patients at one of
the largest children's hospitals in the nation over nearly two decades,
the numbers remain small due to the rarity of the disease; such numbers
continue to illustrate the need for multicenter cooperative group
trials. Also, following the intention-to-treat principle meant all
patients randomized to receive radiation were counted as events,
although the published findings of AHOD0031 likely will similar patients
in the future (RER) will not receive radiation. Additionally, the small
number of late effects precluded meaningful comparisons, although
overall the rate was low with both regimens. We were limited to our
standard length of follow-up and standard late effect surveillance study
results available given the nature of this retrospective chart review.
Finally, due to the nature of patient heath documentation maintenance,
and the lack of electronic medical records for the patients who were
treated in the earlier years, the data collection, such as radiology and
outside records, was limited for some.

In conclusion, our study demonstrated that the ABVD and ABVE-PC regimens
had similar survival outcomes without excess late effects. We found that
patients under the ABVE-PC regimen required more radiation, although the
question of radiation randomization in AHOD0031 increased the number of
patients receiving ABVE-PC that ultimately required radiotherapy.
Nonetheless, the rate of second malignant neoplasms and other late
effects appeared to be low.

\emph{Acknowledgements}

The research team would like to acknowledge Sherri Carcich, RN, who
maintains the clinical database of patients diagnosed with leukemias and
lymphomas at Children's Hospital Los Angeles and assisted with patient
identification.

\textbf{References}

1. Giulino-Roth L, Keller FG, Hodgson DC, Kelly KM. Current approaches
in the management of low risk Hodgkin lymphoma in children and
adolescents. Br J Haematol. 2015;169:647--60.

2. Kelly KM. Management of children with high-risk Hodgkin lymphoma. Br
J Haematol. 2012;157:3--13.

3. Santoro A, Bonadonna G, Valagussa P, Zucali R, Viviani S, Villani F,
et al. Long-term results of combined chemotherapy-radiotherapy approach
in Hodgkin's disease: superiority of ABVD plus radiotherapy versus MOPP
plus radiotherapy. J Clin Oncol. 1987;5:27--37.

4. Chisesi T, Bellei M, Luminari S, Montanini A, Marcheselli L, Levis A,
et al. Long-Term Follow-Up Analysis of HD9601 Trial Comparing ABVD
Versus Stanford V Versus MOPP/EBV/CAD in Patients With Newly Diagnosed
Advanced-Stage Hodgkin's Lymphoma: A Study From the Intergruppo Italiano
Linfomi. J Clin Oncol. 2011;29:4227--33.

5. Hequet O, Le QH, Moullet I, Pauli E, Salles G, Espinouse D, et al.
Subclinical Late Cardiomyopathy After Doxorubicin Therapy for Lymphoma
in Adults. J Clin Oncol. 2004;22:1864--71.

6. Paoli D, Rizzo F, Fiore G, Pallotti F, Pulsoni A, Annechini G, et al.
Spermatogenesis in Hodgkin's lymphoma patients: a retrospective study of
semen quality before and after different chemotherapy regimens. Hum
Reprod. 2016;31:263--72.

7. Straus DJ. Long-term survivorship at a price: late-term,
therapy-associated toxicities in the adult Hodgkin lymphoma patient.
Ther Adv Hematol. 2011;2:111--9.

8. Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Wells WA, Winter
JN, et al. ABVD Alone versus Radiation-Based Therapy in Limited-Stage
Hodgkin's Lymphoma. N Engl J Med. 2012;366:399--408.

9. Friedman DL, Chen L, Wolden S, Buxton A, McCarten K, FitzGerald TJ,
et al. Dose-Intensive Response-Based Chemotherapy and Radiation Therapy
for Children and Adolescents With Newly Diagnosed Intermediate-Risk
Hodgkin Lymphoma: A Report From the Children's Oncology Group Study
AHOD0031. J Clin Oncol. 2014;32:3651--8.

10. Schwartz CL, Constine LS, Villaluna D, London WB, Hutchison RE,
Sposto R, et al. A risk-adapted, response-based approach using ABVE-PC
for children and adolescents with intermediate- and high-risk Hodgkin
lymphoma: the results of P9425. Blood. 2009;114:2051--9.

11. Henderson TO, Parsons SK, Wroblewski K, Chen L, Hong F, Smith SM, et
al. Outcomes in Adolescents and Young Adults (AYA) with Hodgkin Lymphoma
(HL) Treated on US Cooperative Group Protocols: An Adult Intergroup
(E2496) and Children's Oncology Group (COG AHOD0031) Comparative
Analysis. Blood. 2015;126:2636--2636.

12. Giulino-Roth L, Pei Q, Buxton A, Bush R, Wu Y, Wolden SL, et al.
Subsequent malignant neoplasms among children with Hodgkin lymphoma: a
report from the Children's Oncology Group. Blood. 2021;137:1449--56.

13. Stieglitz E, Dinh T, Phelps AS, Pampaloni MH, Olshen AB, Robbins E.
ABVD Without Radiation for Newly Diagnosed Pediatric and Young Adult
Patients With Hodgkin Lymphoma: A Single Center Retrospective Analysis
of 28 Consecutive Patients. J Pediatr Hematol Oncol. 2018;40:290--4.

14. Ingley KM, Nadel HR, Potts JE, Wilson DC, Eftekhari A, Deyell RJ.
The Utility of PET/CT in Guiding Radiotherapy Reduction for Children
With Hodgkin Lymphoma Treated With ABVD. J Pediatr Hematol Oncol.
2020;42:e87--93.

15. Hodgson DC, Hudson MM, Constine LS. Pediatric hodgkin lymphoma:
maximizing efficacy and minimizing toxicity. Semin Radiat Oncol.
2007;17:230--42.

16. Frick MA, Vachani CC, Hampshire MK, Bach C, Arnold-Korzeniowski K,
Metz JM, et al. Patient-Reported Survivorship Care Practices and Late
Effects After Treatment of Hodgkin and Non-Hodgkin Lymphoma. JCO Clin
Cancer Inform. 2018;2:1--10.

17. Chow LML, Nathan PC, Hodgson DC, Jenkin D, Weitzman S, Grant RM, et
al. Survival and Late Effects in Children With Hodgkin's Lymphoma
Treated With MOPP/ABV and Low-Dose, Extended-Field Irradiation. J Clin
Oncol. 2006;24:5735--41.

18. Kahn JM, Kelly KM, Pei Q, Bush R, Friedman DL, Keller FG, et al.
Survival by Race and Ethnicity in Pediatric and Adolescent Patients With
Hodgkin Lymphoma: A Children's Oncology Group Study. J Clin Oncol Off J
Am Soc Clin Oncol. 2019;37:3009--17.

19. Kahn JM, Keegan THM, Tao L, Abrahão R, Bleyer A, Viny AD. Racial
disparities in the survival of American children, adolescents, and young
adults with acute lymphoblastic leukemia, acute myelogenous leukemia,
and Hodgkin lymphoma. Cancer. 2016;122:2723--30.

20. Grubb WR, Neboori HJ, Diaz AD, Li H, Kwon D, Panoff J. Racial and
Ethnic Disparities in the Pediatric Hodgkin Lymphoma Population. Pediatr
Blood Cancer. 2016;63:428--35.

Figure Legends

\textbf{Figure 1 -- Event-free survival and overall survival.} A:
Event-free survival as defined by time to first relapse or last-known
follow-up if still in first remission. B: Overall survival, as defined
by time to death or to last-known follow-up if still alive. ABVD:
Adriamycin, Bleomycin, Vinblastine, Dacarbazine. ABVE-PC: Adriamycin,
Bleomycin, Vincristine, Etoposide, Prednisone, Cyclophosphamide

ImageEFSOS\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}

\textbf{Hosted file}

\verb`Table1Demographics.docx`  available at \url{https://authorea.com/users/437407/articles/539061-survival-of-pediatric-hodgkin-lymphoma-patients-treated-with-doxorubicin-bleomycin-vincristine-etoposide-prednisone-and-cyclophosphamide-abve-pc-versus-adriamycin-bleomycin-vinblastine-and-dacarbazine-abvd-at-a-single-institution}

\textbf{Hosted file}

\verb`Table2PrognosticFactors.docx`  available at \url{https://authorea.com/users/437407/articles/539061-survival-of-pediatric-hodgkin-lymphoma-patients-treated-with-doxorubicin-bleomycin-vincristine-etoposide-prednisone-and-cyclophosphamide-abve-pc-versus-adriamycin-bleomycin-vinblastine-and-dacarbazine-abvd-at-a-single-institution}

\textbf{Hosted file}

\verb`Table3TreatmentDetails.docx`  available at \url{https://authorea.com/users/437407/articles/539061-survival-of-pediatric-hodgkin-lymphoma-patients-treated-with-doxorubicin-bleomycin-vincristine-etoposide-prednisone-and-cyclophosphamide-abve-pc-versus-adriamycin-bleomycin-vinblastine-and-dacarbazine-abvd-at-a-single-institution}

\textbf{Hosted file}

\verb`Table4LateEffects.docx`  available at \url{https://authorea.com/users/437407/articles/539061-survival-of-pediatric-hodgkin-lymphoma-patients-treated-with-doxorubicin-bleomycin-vincristine-etoposide-prednisone-and-cyclophosphamide-abve-pc-versus-adriamycin-bleomycin-vinblastine-and-dacarbazine-abvd-at-a-single-institution}

\selectlanguage{english}
\FloatBarrier
\end{document}

