Clinical characteristics and prognostic factors in patients with Hodgkin lymphoma

Abstract

Objective To investigate the clinical characteristics and prognostic factors of Hodgkin lymphoma (HL). Methods From April 2011 to December 2017, a total of 62 patients with HL who diagnosed and hospitalized in the Department of Hematology, Affiliated Hospital of Xuzhou Medical University were selected as study subjects. Patients who met the following criteria were included in this study: ① pathology-confirmed HL; ② untread; ③ the clinical data such as general clinical data, pathological examinations, laboratory tests, and medical imaging examination results were complete; ④ long-term (up to 1 month) follow-up visits were conducted by telephone or in clinic. Cases were excluded if the patients had received treatment previously or had a history of other malignant tumors. The patients′ route features, clinical manifestations and outcomes were analyzed retrospectively. Kaplan-Meier method was used for survival analysis. Log-rank method was used for univariate analysis of HL patients′ general clinical data, and COX proportional hazard regression model was used for multivariate analysis. Results ① Of these 62 HL patients, male were 40 cases (64.5%), and female were 22 cases (35.5%), the median age at the onset was 36 years old ranging from 5 to 76 years old, and 17 cases (27.4%) were older than 55 years old. According to the Ann Arbor Staging Classification, there were 27 cases (43.5%) in limited stage (Ana ArborⅠ-Ⅱ stage) and 35 cases (56.4%) with advanced stage (Ana Arbor Ⅲ-Ⅳ stage). There were 38 cases (61.3%) with an International Prognostic Score (IPS) of 0-2 and 24 cases (38.7%) had a score of 3 or higher. There were 32 cases (51.6%, 32/62) with B symptoms, 18 cases (29.0%, 18/62) with splenomegaly and 23 cases (37.1%, 23/62) in extranodal sites. For the all 62 patients, 35 cases (56.5%) had complete remission (CR), 15 cases (24.2%) had partial remission (PR), 7 cases (11.3%) had stable disease (SD) and 5 cases (8.1%) experienced progressive disease (PD). The total response rate of these 62 HL patients was 80.6% (50/62). ② The 2- and 3-year overall survival (OS) rates were 93.3% and 90.8%, respectively. The 2- and 3-year progression free survival (PFS) rates were 81.1% and 74.5%, respectively.③ In univariate analysis, age, hemoglobin (Hb) level and β2-microglobulin (MG) level had a statistically significant prognostic impact in OS rates of these 62 HL patients (χ2=6.073, 5.611, 5.098; P=0.014, 0.018, 0.024). And Hb level, absolute mononuclear cell count (AMC) level and β2-MG level had a statistically significant prognostic impact in terms of PFS rate (χ2=6.182, 6.340, 6.173; P=0.013, 0.012, 0.013). The results of multivariate analysis identified that age greater than 55 years old as a independent prognostic factor for OS rate of HL patients (HR=4.583, 95%CI: 1.214-17.295, P=0.025). And AMC>0.6×109/L、β2-MG level>2 366 ng/mL remained independent prognostic factors for PFS rate of HL patients (HR=17.853, 95%CI: 3.429-92.955, P=0.001; HR=14.763, 95%CI: 3.420-63.738, P<0.001). Conclusions Patients with HL have a good prognosis. The multivariable analysis identified that age greater than 55 as an independent prognostic factor for OS, and high AMC, and high β2-MG for PFS. Key words: Hodgkin lymphoma; Drug therapy, combination; Radiotherapy; Overall survival; Progression-free survival; Prognosis