Abstract
BackgroundHodgkin’s lymphoma (HL) is one of the most curable malignancies with a 5-year survival of over 80%. Most published literature from low-middle income countries comes from single institute experience.MethodologyThe OncoCollect Lymphoma group registry was set up in 2017 and has 9 major participating sites across India. Data of newly diagnosed classical HL (CHL) patients, treated between 2011 and 2017, were collected using OncoCollect software. The clinical features, subtypes, prognostic stratification, treatment patterns, response to first-line treatment, and 5-year outcomes were analyzed. All statistical analysis was done using Microsoft R Open statistical software linked to OncoCollect software.ResultsThere were 939 newly diagnosed CHL patients with a median age of 38 (range, 18–99) years at presentation. The male-to-female ratio was 2.07:1. Histological subtypes included mixed cellularity, CHL (MC, CHL), nodular sclerosis, CHL (NS, CHL), lymphocyte-rich, CHL (LR, CHL), and lymphocyte-depleted, CHL (LD, CHL), in 60.60%, 26.94%, 9.80%, and 2.66%, respectively. At presentation, 50.43% had B symptoms and 53.35% had advanced disease. 29.71% of advanced-stage patients had high Hodgkin IPI score. 79% and 21% of patients received 1st-line treatment with chemotherapy alone or combined modality treatment with chemotherapy and radiotherapy. The most common first-line chemotherapy was ABVD-based regimen (94.68%). The overall response rate was 93.48%. Complete response rates among early-stage favorable and unfavorable risk groups were 92.73% and 86.79%, and those among advanced-stage low- and high-risk groups were 76.64% and 69.78%, respectively. The median relapse-free follow-up duration was 51 months (IQR 22–69). A significant difference was found in 5-year EFS between the early- and advanced-stage disease 83.53% and 73.55% (p = 0.00087), respectively. Similarly, significant difference was found in EFS among early-stage patients treated with a combination of 4-cycle chemotherapy and radiotherapy vs. chemotherapy alone 88.57% and 66.33% (p = 0.0042), respectively.ConclusionsIn this large cohort from India, survival of patients with HL was comparable to the developed world. With a median follow-up of 51 months, the 5-year EFS and OS of all patients were 78.24% and 83.63%, respectively.
Highlights
Long-term outcomes of Hodgkin lymphoma (HL) have been reported from single-center retrospective studies from India [1–4]
The secondary objective were to study the treatment patterns based on prognostic risk stratification. This was designed as a retrospective, multi-institutional, observational study to report clinical features at presentation and analyze outcomes of patients diagnosed between January 2011 and December 2017
A total of 1,285 patients (≥18 years) with WHO classification of HL were registered in the database. 939 treatment-naive classical HL (CHL) patients were considered evaluable for first-line treatment response and outcome. 51 patients with nodular lymphocytic predominant HL and 295 patients who presented post relapse or had less than 4 visits in the outpatient clinic with no definite treatment prescribed at the participating centers were excluded from this audit
Summary
Long-term outcomes of Hodgkin lymphoma (HL) have been reported from single-center retrospective studies from India [1–4]. Given that lymphoma patients are mostly treated in tertiary cancer centers, specialty hospitals, and academia with uniform protocols, data from these centers were captured. The OncoCollect Lymphoma Registry was set up in 2017 to address the previous challenges in collecting retrospective data largely at a time when chart reviews were the main data source. Participating institutions are given the rights to export data, and the OncoCollect exports anonymized data to the Registry. Both academic and community practices are a part of the registry. Each institute is responsible for entering data onto the OncoCollect software developed by the Ramesh Nimmagadda Cancer Foundation (RNCF).
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