QUALITY OF LIFE IN PEDIATRIC HIGH‐RISK HODGKIN LYMPHOMA TREATED WITH BRENTUXIMAB‐BASED INTENSIVE CHEMOTHERAPY—COMPARISON TO HISTORICAL TREATMENT COHORT AND HEALTHY PEERS

Abstract

Introduction: Hodgkin lymphoma (HL) in children, adolescents, and young adults (CAYA) is highly curable. Patient experiences during cancer treatment vary substantially and may influence later quality of life (QOL). We sought to: (1) describe patient-reported QOL during treatment for high-risk classical HL in CAYA with HLHR13, a brentuximab-incorporating chemotherapy regimen with response-adapted radiotherapy (r-aRT); (2) compare QOL among patients treated on HLHR13, high-risk HL patients treated with Stanford V chemotherapy and r-aRT (HOD99), and healthy CAYA. Methods: Eligible patients were ≤18 (HLHR13) or ≤21 years old (HOD99) upon diagnosis of Stage IIB, IIIB, or IV HL. For HLHR13 and HOD99, QOL was assessed with PedsQL 4.0 Generic Core Scales and PedsQL 3.0 Cancer Module. HLHR13 consisted of 2 “AEPA” cycles (brentuximab, etoposide, prednisone, and doxorubicin) and 4 “CAPDac” cycles (cyclophosphamide, brentuximab, prednisone, and dacarbazine) with r-aRT (25.5 vs. 0 Gy). HLHR13 chemotherapy lasted 20 weeks including 6 rest weeks. HOD99 consisted of 12 weeks of Stanford V (bleomycin, doxorubicin, mechlorethamine, prednisone, vinblastine, and vincristine) with r-aRT (25.5 vs. 15 Gy). Despite differing regimen durations, QOL assessments were compared at timepoints considered equivalent. HLHR13 incorporated 2-year off-therapy long-term follow up QOL assessments. Patient demographics and QOL scores were summarized by descriptive statistics. We used Wilcoxon rank-sum tests to compare PedsQL 3.0 scores in HLHR13 patients vs. HOD99 patients and pooled two sample t-tests to compare patient and healthy CAYA PedsQL 4.0 scores. Raw p-values were corrected for multiple comparisons. Results: At study entry, HLHR13 patients’ (n = 63) QOL was significantly worse than healthy CAYA and consistent with HOD99 patients’ (n = 78) QOL as measured by PedsQL 4.0 Generic Core Scales. HLHR13 patients’ QOL gradually improved. Compared to HOD99 patients, HLHR13 patients had better cancer-specific QOL scores (PedsQL 3.0 Cancer Module) during treatment, particularly for nausea, worry, cognitive problems and treatment anxiety. Two years off therapy, HLHR13 patients (n = 39) reported better QOL in social and emotional domains than did healthy CAYA. Conclusions: Among similar groups of CAYA with HL, HLHR13 treatment was associated with higher patient-reported cancer-specific QOL than was HOD99 despite longer treatment duration and more intensive administration schedule. PedsQL 3.0 Cancer Module distinguished cancer-specific experience differences between HLHR13 and HOD99. Mechlorethamine in HOD99 may have produced excess nausea. Two years after treatment, HLHR13-treated CAYA reported better social and emotional QOL than healthy peers. Observed excellent QOL could reflect positive psychosocial impacts of living beyond lymphoma or a biased group of CAYA continuing in survivorship care. Keywords: chemotherapy, late effects in lymphoma survivors, Hodgkin lymphoma The research was funded by: St. Jude Children's Research Hospital and Seagen Inc Conflicts of interests pertinent to the abstract: M. P. Link Research funding: Seagen, Inc J. E. Flerlage Research funding: Seagen, IncSS