Abstract A11: The international prognostic score and HIV status predict red cell concentrate transfusion need in Hodgkin Lymphoma

Abstract

Abstract Background There is a significant burden of anaemia in advanced Hodgkin Lymphoma (HL) in an HIV burdened setting, however there is a paucity of data evaluating red cell concentrate (RCC) transfusion in newly diagnosed HL receiving treatment. We performed a retrospective study to determine predictors of transfusion. Methods Patients 13 years and older consecutively diagnosed with and treated for HL from 2010 to 2019 in Groote Schuur Hospital, University of Cape Town, were retrospectively studied. Patients were staged according to the Lugano classification, with clinical staging according to the National Cancer Comprehensive Network and categorized with both the HL International Prognostic Score (IPS)-7 and the HL IPS-3. Results Two hundred and eighty-five patients received first-line treatment for HL from 2010 to 2019. Patients had a median age of 34.5 years and were predominantly male (62.9%). The HIV prevalence was 39.5% and majority of patients (74.2%) had advanced disease. Bone marrow involvement was confirmed in 41% of cases by trephine examination or PET-imaging; the majority (35%) of these cases the bone marrow appeared to be the primary site with no lymphadenopathy peripherally or on imaging. Primary bone marrow HL was strongly associated with HIV infection. RCC transfusion was observed in 24.6% patients, with significantly more HIV-positive patients (40.4%) transfused than HIV-negative patients (14.1%) (P<0.001). The median number of transfusions for the total cohort was 2 (IQR 1-5). HIV-positive patients received significantly more RCC units (median 3, IQR 2-5) than HIV-negative patients (median 2, IQR 1-3); P=0.035. In univariable logistic regression, each one-point increase in HL IPS-7 was associated with a two-fold increase in the odds of transfusion, while each one-point increase in HL IPS-3 was associated with a two-and-a-half-fold increase in the odds of transfusion. In multivariable analyses, HL IPS-7 and HIV positivity were significantly associated with transfusion after adjusting for B symptoms and ECOG. Similar results were observed after replacing the HL IPS-7 with HL IPS-3. Conclusion The HL IPS-7 as well as HIV status proved to be strong predictors of RCC transfusion need in a newly diagnosed HL cohort in the developing world. The HL IPS-3 consisting of only age, haemoglobin and Lugano stage IV, is equally predictive of transfusion need and simple in use. Lugano stage IV was a surrogate marker for the high (41%) HL bone marrow involvement. Citation Format: Estelle R Verburgh, Kudakwashe Simba, Zainab Mohamed, Jessica J Opie, Karryn Brown, Jenna Oosthuizen, Katherine R Antel, Lillian Andera, Cecile du Toit, Vernon J Louw. The international prognostic score and HIV status predict red cell concentrate transfusion need in Hodgkin Lymphoma [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A11.