Management of Classical Hodgkin's Lymphoma: Single Center Experience from Tawam Hospital, United Arab Emirates

Classical Hodgkin's lymphoma (cHL) is an uncommon lymphoproliferative disorder. In general Hodgkin's lymphoma is a disease of the younger population affecting mostly patient of 15 to 30 years of age. There is second peak of incidence noticed among older population of 70 years of age or more.

Histologically, Hodgkin's lymphoma is broadly classified into nodular lymphocyte predominant or classical Hodgkin's lymphoma which is further sub classified into 4 subtypes: lymphocyte-rich, lymphocyte-depleted, mixed cellularity and nodular sclerosis. The commonest subtype is the nodular sclerosis which accounts for 70% of the cases of classical HL, this is followed by the mixed cellularity subtype which account for 20 to 25% of the cases. cHL is characterized by the presence of the Reed Sternberg cells (HRS cells) within a background of non-malignant inflammatory cells. Most patient with advanced stage Hodgkin's lymphoma in general are managed with either the 6 to 8 cycles of ABVD combination chemotherapy or 6 cycles of escalated BEACOPP.

In this retrospective study, we reviewed the cHL patient's demographics, management and their outcome in our center. The data base in this institution was searched over 5 year's period (January 2011 to December 2015). 29 patients were identified to be included in the study however one patient was lost to follow up so the outcome of his disease could not be traced. Data was collected regarding age, sex, stage, International prognostic index (IPI), treatment and outcome.

The median age was 50 years (range 21 to 62 years). Out of the total number, 57% were males (N 16) and 43% were females (N 12). In terms of the histological subtypes of our cohort, the commonest was the nodular sclerosis subtype which occurred in 75% (N 21) followed by mixed cellularity 25 % (N 7)

Most of the patients were diagnosed with early stage disease (stage 1-2) 71 % (N 20) while the rest had advanced stage disease. In terms of the international prognostic scoring stratification, the majority are of good risk group with IPI score 1 at 43% (N 12), IPI score 2 at 25% (N 7), while IPI score 3 is 14% (N 4), IPI score 4 is 11% ( N 3) and IPI score 5 is only in 7% ( N 2) of the patients.

The majority of patients were managed with ABVD combination chemotherapy with excellent outcome as 85 % of our evaluated patients achieved complete response at the end of their treatment course. Only 15 % of the patients had residual disease at the end of their treatment. One patient received BEACOPP combination chemotherapy, his IPI scorewas 3 and he had persistent disease at the end of his treatment. Although the number of the patients included is small, our study confirmed that ABVD protocol is an excellent regimen for the treatment of classical Hodgkin's lymphoma. This is shown in a significant number of our patient achieving complete response after receiving 6 to 8 cycles of ABVD.