Treatment patterns, outcomes and long-term toxicity among patients with Hodgkin’s lymphoma in real world: results of a hospital based registry

Data on treatment results and long-term toxicity of patients with Hodgkin’s lymphoma in Russian Federation are scarce. We present analysis of the S. P. Botkin Hospital based registry. Six hundreds nine patients were identified since 01.01.2006 to 31.12.2015, among them there were 374 (61 %) women and 235 (39 %) men. The median age was 31 years (range, 15–85). One hundred sixty four patients (29 %) had Cotswolds stage IV, 128 (22,5 %) – stage III, 256 (45 %) – stage II, and 20 (3,5 %) – stage I. Among first-line regimens ABVD was received by 26 % of patients, AVD – 1,2 %, COPP/ABVD – 5,6 %, BEACOPP-14 – 22 %, BEACOPP-21 – 19 %, BEACOPP escalated – 2,8 %, EACOPP – 2,6 %, ABVD-BEACOPP – 2,9 %. Sixty seven (11 %) patients received other regimens, including MOPP-ABVD, LABO, LOPP, CEA/ABVD, CHOP and irradiation only. Radiotherapy was given to 81 % of patients. Long-term remission after first-line therapy was achieved in 432 patients (75,2 %). Second-line treatment was required in 117 patients (20,4 %). Twenty five patients (4,4 %) died before second-line therapy. High dose therapy with autologous stem cells rescue (HDCT-ASCT) was conducted in 26 of 117 (22 %) patients with relapse after first-line treatment. Five-year overall survival in early stage patients, receiving ABVD was 96 % and 85 % in those, receiving other regimens. In patients with advanced stages no differences in overall survival were found when comparing BEACOPP
modifications with other regimens. Time to next treatment (TTNT) was different: 5-year TTNT rate was 71 % in BEACOPP group compared to 56 % in patients, receiving other regimens. BEACOPP-escalated and BEACOPP-14 had an advantage over BEACOPP-21: 5-year TTNT rate was 80, 77 and 63 %, respectively.
Long-term toxicity was analyzed by comparing HL patients with age and sex-matched control group, consisting of patients, hospitalized to S. P. Botkin City Hosiptal betwen 01.01.2008 and 01.01.2009 for trauma or infection (n = 555). Standardized incidence ratio (SIR) of developing secondary malignancies was 3,56. SIR of developing all cardiac events, including myocardial infarction, heart failure or cardiac arrhythmia was 2,97. The implications of these findings suggests several ways in which quality of care of HL patients can be improved. These measures include widespread use of PET for precise staging, improvement in integrated care pathways, education of patients, the abandonment of radiotherapy or reduction of volumes and doses of irradiation, greater use of HDCT-ASCT and targeted agents.

Hodgkin’s lymphoma, registry, ABVD, BEACOPP, long-term toxicity, chemotherapy-induced cardiotoxicity, secondary malignancies

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