Prognostic Factors for Survival in 60 Patients with Classical Hodgkin Lymphoma From Peru

Hodgkin lymphoma (HL) is an uncommon lymphoma with a good prognosis. However, the characteristics of HL in Peruvian patients have not been previously reported. HL is thought to be related to chronic Epstein Barr virus (EBV) infection, and new biological markers such as EBV, CD68 and FOXP3 expression could be of potential biological interest in this entity. Our study aims to identify prognostic factors for survival in Peruvian patients with classical HL.

This study was approved by the IRB at our institution. Between January 2001 and December 2009, patients diagnosed with classical HL were selected for this study. HIV-negative patients were excluded. Clinical data were reviewed retrospectively and patient's biopsies were analyzed for the immunohistochemical expression of CD20, PAX5, CD30, CD15, FOXP3 and CD68. Samples were also analyzed for the presence of EBV-encoded RNA (EBER) using an in situ hybridization (ISH) technique. Clinicopathological characteristics will be presented using descriptive statistics. Overall survival (OS) estimates were calculated using the Kaplan-Meier method and compared using the log-rank test. For the multivariate survival analysis, Cox proportional-hazard regression test was used. P-values <0.05 were considered statistically significant.

A total of 60 patients with a pathological diagnosis of classical HL were included in our study. The median age was 55 years (range: 18–98 years) with a 7:3 male predominance. Advanced stages (stage 3 and 4) were seen in 52%, ECOG performance status >1 in 15% and B symptoms in 67%. White blood cell (WBC) counts >15,000 cells/mm³ was seen in 7%, lymphocyte count <600 cells/mm³ in 12%, albumin levels <4 g/dl in 70% and hemoglobin <10.5 g/dl in 40% of the patients. FOXP3 expression >25% was seen in 45%, CD68 >25% in 48% and EBER 2–3+ in 53%. ABVD was the preferred therapy, accounting for 90% of the cases and a complete response to ABVD was obtained in 78%. With a median follow-up 34 months, the median overall survival (OS) has not been reached and the 5-yr OS was 80%. In the univariate analysis, ECOG >1 (p=0.0001), elevated LDH levels (p=0.04) and lymphocyte count <600 cells/mm3 (p=0.05) were adverse prognostic factors. Age, sex, B symptoms, WBC, albumin and hemoglobin levels were not associated with survival. In the multivariate analysis, only ECOG >1 (p=0.01) was an independent adverse prognostic factor in Peruvian patients with classical HL.

ECOG is a best prognostic factor in Peruvian patients with a diagnosis of classical Hodgkin lymphoma. CD68 expression, EBV status and FOXP3 expression by the malignant cells were not prognostic factors for OS in our cohort of patients.

Castillo:GlaxoSmithKline: Research Funding; Millennium Pharmaceuticals: Research Funding.