1. Response to chemotherapy
Survival pattern of Hodgkin’s Lymphoma patients in the last 25 years in Lebanon
1M.Massoud,1F.Kerbage,1J.Nehme,1R.Sakr,1L.Rached,1J.Zeghondy,2F.Nasr,2G.Chahine.
1Holy Spirit University of Kaslik, medical school, Lebanon2Saint Joseph University, medical school, Lebanon.
Introduction
Methods
Results
Discussion
Conclusion
The management of Hodgkin lymphoma (HL) has changed over the past few decades. Historically, the backbone treatment was radiation alone. The long-term treatment-related toxicities may be fatal including second cancers and cardiovascular events mainly*. In the 1960s, DeVita introduced the first combination chemotherapy at the National Cancer Institute. It consisted of Mustargen, Oncovin, Procarbazin and Prednisone (MOPP regimen). It provides good response at the price of high toxicity and secondary malignancies. Years later, the ABVD regimen (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) has emerged as a new standard of care achieving better disease control with less toxicities, and thus, improved long-term survival. In the early 2000, all studies showed that decreasing the dose of radiation therapy results in less long-term toxicity without affecting survival rates. Moreover, the improvement of staging techniques, the recognition and the management of treatment-related late toxicities had positively affected survival.
The male to female sex ratio was The median age at diagnosis was 32.7 years in Group A, 30.4 years in group B and years in group C (p=0.6). Only classical Hodgkin lymphoma was included in our study. Major subtypes distribution between the different groups was as follow: Scleronodular HL in 59.5% of patients in Group A, 76.2% in group B and 85.4% in group C. Mixed Cellularity HL in 21.6% of patients in Group A, 2.4% in group B and 8.7% in group C (p=0.0001). Percentage of patients presented with localized disease was 58.6%, 73.7% and 56.4% in Group A, B and C respectively (p=0.173). Complete remission was achieved in 76.5% of patients in Group A, 85.3% and 69.5% in Group B & C (p=0.007).The 5-year survival rate were 91%, 94% and 100% in Group A, B & C respectively.
Management of classical Hodgkin lymphoma has witnessed many successes over the past few years leading to improved survival rates. Our study showed that the 5-year survival rate of classical Hodgkin lymphoma patients was 91% from 1990 to 1999, 94% from 2000 to 2009 and 100% from 2010 to 2015, compared to 89%, 92% and 98% respectively as described in the literature. These observations are consistent with the international data registries for long-term survival.
After the year 2000, the rapid integration of involved field radiation at a lower dose (20 Gy) showed less long-term treatment-related toxicities such as secondary neoplasms which can exceed 10% in some series, leading to improved long-term-survival, especially important for our young target population.
After 2010, the introduction of PET-CT in the staging & evaluation of treatment response of Hodgkin lymphoma allows accurate staging of the disease, tailor the treatment & minimize the eventual toxicities . Our data showed that survival has reached almost 100% in group C. This may be biased by the short follow-up period and the small sample size. Nevertheless, the integration of targeted therapy & immunotherapy as salvage protocols may favor the long-term survival of Hodgkin lymphoma patients in the refractory disease settings.
The survival of HL patients has dramatically improved over the last 25 years in Lebanon. Our results are comparable to those achieved in western countries. This can be explained by the fast adoption & integration of new functional imaging technique for diagnosis and follow-up of the disease, as well as by the rapid approval of new emerging drugs in the relapse settings in the Lebanese market.
We retrospectively reviewed the chart of 196 patients newly diagnosed, biopsy confirmed having classical Hodgkin lymphoma, treated and followed between 1990 and 2015 in our center in Lebanon. Patients were divided into three groups according to the time of diagnosis: Group A ( ), Group B ( ) and Group C ( ).The time cut off was chosen based on the milestone changes in the treatment strategies of Hodgkin lymphoma in Lebanon following the word wild recommendations. We studied the baseline characteristics and survival pattern of patients in each group.
References
1. Treatment of newly diagnosed advanced stage Hodgkin lymphoma. Jieun Uhm, John Kuruvilla. © 2012 Elsevier
2. Association of intensity-modulated radiation therapy on overall survival for patients with Hodgkin lymphoma. Rahul R. et al Elsevier Ireland Ltd. Radiotherapy and Oncology 118 (2016) 52–59
3. Hodgkin lymphoma in the elderly: A clinical review of treatment and outcome, past, present and future S.J. Proctor ∗, J. Wilkinson, M. Sieniawski. Critical Reviews in Oncology/Hematology 71 (2009) 222–232
4. Immunotherapies for Hodgkin’s lymphoma
Yvette L. Kasamon∗, Richard F. Ambinder. Critical Reviews in Oncology/Hematology 66 (2008) 135–144
5. Association of intensity-modulated radiation therapy on overall survival for patients with Hodgkin lymphoma. Rahul R. et al. Radiotherapy and Oncology 118 (2016) 52–59
Baseline characteristics
Group A
(90- 99)
Group B (00-09)
Group C
(10-15)
Sex (%)
Female
48.6
54.8
45.6
Male
51.4
45.2
54.4
Age (%)
< 40 y
78.8
83.3
75.5
> 40 y
21.2
16.7
24.3
Subtype (%)
Sclero-nodular HL
59.5
76.2
85.4
Mixed cellularity HL
21.6
2.4
8.7
Lymphocyte depletion HL
5.4
14.3
5.8
Lymphocyte rich HL
2.7
Stage (%)
I & II
58.6
73.3
56.4
III & IV
41.4
26.3
43.6
Response to chemotherapy
(%) CR
76.5
85.3
69.5 PR
2.9 22
Progression
17.6
8.8
8.5
Stability
5.9
Objective
To compare the overall survival over three different decades of patients with Hodgkin lymphoma in Lebanon.
Contact
Massoud Marcel
Figure 1: 5-year survival rate in group A, B & C.