Excellent outcome in Hodgkin lymphoma with ABVD and CMT: A single‐centre retrospective analysis

Abstract

Background: ABVD alone or in combination with radiotherapy(CMT) is the mainstay of therapy for Hodgkin lymphoma (HL). We retrospectively evaluated outcome of HL patients followed up at Haemato Oncology Care Centre, Vadodara, India, between 2007 to 2016. Methods: Sixty-three patients were analysed for this study, males 65% (n = 41), females 35% (n = 22). The median age was 28 years (range, 8 y to 75 y). Classical Hodgkin lymphoma 93% (n = 59) and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) 7% (n = 04). Stage I 1.6% (n = 1), Stage II 25.4%(n = 16), Stage III 58.6%(n = 37), Stage IV 14.3%(n = 09). B symptoms present in 58.6% (n = 37), Bulky disease in 12% (n = 8). ABVD 6 cycles given to Stage IIB, III, IV, and 4 cycles given to (II A). All patients with Bulky disease 9.6% (n = 6) received radiation therapy post completion of ABVD.Two patients with bulky disease (3%) refused to take radiation therapy. Interim PET post 2 cycles of ABVD done in all patients. Bone marrow examination at the end of treatment done only in patients with Stage IV disease. One patient of NLPHL Stage I did not receive any treatment, follow up every 3 months done. One patient had bilateral pulmonary thrombo embolism at diagnosis, received enoxaparin 1 mg/kg SC, BID till completion of chemotherapy. Kaplan–Meier survival estimates were used to evaluate progression-free survival (PFS) and overall survival (OS). Results: The median follow-up was 49 months (range, 2-107 months). PET CR1 achieved after II cycles of ABVD in 96% (n = 60) and progression of disease in 3.2% (n = 2). Four patients (6%) relapsed within 18 months, of 4 relapsed, 50% (n = 2) patients received salvage chemotherapy (DHAP n = 1,GCD n = 1), both achieved PET CR2. Only 1 patient of CR 2 undergone BEAM auto PBSCT. Five-year PFS and OS were 71.4% and 90.4%, respectively. For early stage (IIA), PFS and OS were 73.1% and 94.1%, respectively, whereas for advance stage (IIB, III, IV), PFS and OS were 69.7% and 86.8%, respectively. Adversed events observed during therapy were pulmonary fibrosis in 6.5% (n = 4), constipation in 3% (n = 2), convulsion in 3% (n = 2), neutropenia grade III, IV % 6.5% (n = 4), peripheral neuropathy 6.5%(n = 4), mucositis with esophagitis 1.6% (n = 1), invasive aspergillosis pneumonia 1.6% (n = 1), fungal nail infection 1.6% (n = 1), herpes zoster 1.6% (n = 1). Posttreatment sequelae observed in total 4.8% patients (n = 3), coronary artery disease n = 1 (3 y post CMT), bilateral idiopathic lower limb edema n = 1 (1 y post ABVD), hepatic epithelial hemanagioendothelioma n = 1 (1 y post auto PBSCT), one patient died of disease progression (post CR2). Lost to follow-up total were 17% (n = 11), with complete remission status 3% (n = 2), with relapse status 4% (n = 3), with progression of disease 3% (n = 2), with disease status not known 6% (n = 4). Conclusions: Patients with HL on ABVD or CMT who achieved PET CR, irrespective of stage and unfavourable risk factor, have an excellent prognosis. Low cost and limited manageable regimen-related toxicity make it feasible to achieve higher cure rate in even economically challenged patients of Hodgkin lymphoma at our centre. Keywords: ABVD; Hodgkin lymphoma (HL)