Hodgkin Lymphoma (HL), A Retrospective Analysis in Young Adults.

INTRODUCTION: Over the last four decades survival of patients with HL has improved. Various risk factors (stage III/IV, abnormal ESR, bulky mediastinal disease, >3 involved nodes, extranodal involvement) classify patients into prognostic groups for treatment accordingly.

PURPOSE: This study was conducted to review the risk factors, treatments and outcomes in young adults with HL over the past 25 years in our Unit.

METHODS: Retrospective chart review of 55 young adults 16–23 years old (25 women, 35 men), treated from 1978–2003, was performed. Patients were divided according to risk factors into three prognostic groups: low (stage I/II without risk factors; 5 patients [9.1%]), intermediate (stageI/II with risk factors; 19 patients [34.5%]) and advanced HL (stage IIB with bulky mediastinal disease and extranodal involvement or stage III/IV; 31 patients [56.4%]). Patients were treated with established chemotherapy regimens available at each time period including MOPP (Group A, 1978–1987; 17 patients), MOPP/ABVD (Group B, 1988–1993; 21 patients), and ABVD or BEACOPP (Group C, 1994–2003; 17 patients). Patients with bulky disease at diagnosis (>5cm) or residual disease following chemotherapy received additional radiotherapy.

RESULTS: Histological diagnosis included 42 nodular sclerosis, 10 mixed cellularity and 3 lymphocyte predominant. Thirty five patients had mediastinal involvement (16 patients with bulky disease). Following chemotherapy completion 27 patients were referred for radiotherapy. A total of 21 patients experienced relapse (5 intermediate and 16 advanced stage), of whom 14 (66 %) within the first 2 years of diagnosis. Although the follow up periods were not equal between the three treatment groups, surveillance of evaluable patients showed significant improvement of the 5-year survival and 5-year relapse rate (Group A:64.7% and 47%, Group B:80.9% and 33.3%, Group C:94.1 % and 11.7% respectively) over the years. Eight out of 10 mixed cellularity patients died. One second primary malignacy (acute non lymphocytic leukaemia) was observed. In our study albumin less than 4 g/dl, and lymphocyte count less than 8% were identified as the most important risk factors in relation to relapse and survival regardless treatment.

CONCLUSION: Survival of young patients with HL is significantly improving over the last 25 years most probably due to improved treatment resources and understanding of risk factors. Tailoring treatment according to prognostic groups and inclusion of molecular markers is expected to refine further treatment strategies and improve survival.