Abstract
Introduction:
Early stage classical Hodgkin lymphoma (cHL) carries good prognosis. Patients with B symptoms have been found to have unfavorable risk. Due to overall good outcome, studies are focusing on minimizing toxicity by omission of consolidative radiation. The aim of our study is to review outcome of this cohort in a population based analysis.
Methods:
All early stage (stage I and II) cHL adult patients diagnosed 2005-2014 were collected through Kentucky Cancer Registry (KCR). Patients reported to have had B symptoms (Unexplained fevers >38°C; drenching night sweats; or weight loss >10% of body weight within 6 months prior to diagnosis) were included in the current study. Baseline characteristics as well as survival outcome were compared between chemotherapy alone and combined chemo-radiation treatment. Pearson Chi-square, log-rank, and cox regression tests were used in the analysis. To minimize selection bias, events during the first 6 months of therapy were censored. 10-year survival data were then compared to Surveillance, Epidemiology and End Results (SEER) registry.
Results:
A total of 130 adult patients were included in the study; 76 patients got chemotherapy alone and 54 patients got chemo-radiation therapy. Median age was 35 (ranged 18-88). Most patients were younger than 50 year-old (76.9%). Most patients had nodular sclerosis (N=91) while 29 patients had unknown histology. There was no statistical difference in pretreatment features between the group receiving chemotherapy and those who received chemo-radiation (See table).
There was no difference in 10-years overall survival between the chemotherapy group (73%) and chemo-radiation (80%) (p=0.830) (See figure). When adjusting for multivariate analysis, age younger than 50 was the only statistically significant variable affecting survival with a HR 0.17 (95% CI: 0.058-0.505). Only 4 (5.3%) patients developed second primary cancer in chemotherapy alone versus 1 (1.9%) in chemo-radiation therapy (p =0.4).
Compared to overall survival in SEER database, younger patients (<50 years old) had worse overall survival (81.9% vs 85.5%) (p<0.001). This was not observed in the older population.
Conclusion:
Our study shows lack of benefit of the combined approach for the management of unfavorable prognosis classical Hodgkin lymphoma in a population based analysis. Younger patients had worse outcome when compared to SEER registry while older age group had worse prognosis with the available therapies and might benefit from alternative interventions.
No relevant conflicts of interest to declare.
