Abstract
Objective:To determine the outcome of patients with early-stage (stage I-II) favorable risk classical Hodgkin lymphoma treated with chemotherapy alone or combined modality treatment (CMT) utilizing chemotherapy and involved field radiotherapy.Methods:This retrospective study was done at Department of Medical oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan from January 2004 to December 2013.Results:There were 101 patients, with male predominance (71.3%). Mean age was 34 years. Sixty three (62.4%) patients received CMT and 38 (37.6%) patients had chemotherapy alone. Ninety eight percent patients had ABVD chemotherapy. Dose of radiotherapy ranged from 20 to 36 gray. Difference between baseline characteristics and major toxicities among the two groups was insignificant. Patients treated with CMT had better overall survival compared to chemotherapy alone: 100% versus 91% at five years and 96% versus 81% at 10 years, respectively (p=0.03). Progression free survival was also better with CMT against chemotherapy alone at five years (98% versus 81%) and 10 years (82% versus 71%) (p=0.01).Conclusion:Favorable risk classical Hodgkin lymphoma patients had better overall survival and progression free survival when treated with CMT against chemotherapy alone
Highlights
Over the past 2-3 decades, incidence of Hodgkin lymphoma (HL) in the western world has remained fairly steady at about 3 per 100000 which are considerably lower than that of non-HodgkinCorrespondence: August 2, 2016 October 15, 2016 lymphoma
Hodgkin lymphoma is divided in Nodular lymphocyte predominant Hodgkin lymphoma and Classical Hodgkin lymphoma which is further sub-classified into four histological types, nodular sclerosis, mixed cellularity, lymphocyte depleted and lymphocyte rich.[2]
Subtotal nodal irradiation (STNI) alone, which consisted of sequential irradiation of the cervical, axillary, mediastinal, and hilarlymphnodes followed by spleen and para-aortic nodes; was standard treatment in the past and it achieved relapse free survival of 80% at ten years.[6,7]
Summary
Over the past 2-3 decades, incidence of Hodgkin lymphoma (HL) in the western world has remained fairly steady at about 3 per 100000 which are considerably lower than that of non-HodgkinCorrespondence: August 2, 2016 October 15, 2016 lymphoma. Over the past 2-3 decades, incidence of Hodgkin lymphoma (HL) in the western world has remained fairly steady at about 3 per 100000 which are considerably lower than that of non-Hodgkin. Mediastinal bulk disease, raised ESR, Bsymptoms (fever > 38oC, drenching night sweats, unexplained weight loss >10% of total body weight over 6 months) and number of involved nodal sites are all known adverse prognostic factors.[3]. These risk factors are usedto segregate patients with early-stage Hodgkin lymphoma (Ann Arbor stage I and II) into 2 groups i.e., favorable-absence of aforementioned factors and unfavorable-presence of these factors.[4,5]. Combined modality treatment (CMT) including chemotherapy and involved field radiation showed better results and with low toxicity profile.[11]
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