Publication Only: Hodgkin lymphoma - Clinical
Hodgkin lymphoma (HL) management is in constant change. The recent introduction of PET guided therapy drew new strategies of its management. There is only few data in literature about the epidemiology and the treatment of this lymphoma in Morocco.
The aim of our study is to describe the characteristics of patients with Hodgkinlymphoma, to document and evaluate the efficacy and tolerance of the therapies used in our department.
We retrospectively reviewed the records of all patients treated for HL between January 2010 and December 2018 in the department of Clinical Hematology of the Military Hospital Mohammed V of Rabat. The clinical and prognostic characteristicswere collected. Treatment outcomes were measured in terms of response rates, overall survival (OS) and progression-free survival (PFS). Quantitative variables weredescribed in terms of mean, median; qualitative variables were described as absolute percentage. Kaplan Meier curves were used to calculate OS and PFS.
94 patient records were analyzed, 18 were excluded due to lack of information. The median age was 39 years.Sex ratio at diagnosis was 1.88. The median time to first consultation was 23.5 weeks. Peripheral lymphadenopathy was the most frequent clinical finding (84%). The diagnosis was confirmed on a lymph node biopsy in 87% of cases; the nodular sclerosis type was the most common (77%).All patients had initial Computed Tomography and 52% were staged by 18F-FDG PET/CT. Bone marrow biopsy was performed in 46% patient.52% of patients had early-stage disease (2.5% stage IB, 22% stage IIA and 27.5% stage IIB). 48% of patients had advanced-stage disease (2.5% stage IIIA, 15% stage IIIB, 2.5% stage IVA and 28% stage IVB). The patients with early-stage disease were stratified according to the EROTC prognostic score: 76.2% had unfavorablerisk score and 23.8% were favorable. The advanced stages were stratified according to the international prognostic score (IPS): 5.5% were ranked favorable, 51.5% intermediate and 43% were high risk.Patients with early-stage received as initial chemotherapy ABVD in 53,5 %, BEACOPP escaladed in 41,5% and BEACOPP standard in 5%. Patients with advanced-stage were treated by BEACOPP escaladed in 89% and ABVD in 11%. An ”involved-field“ irradiation was performed in 60% of patients with early-stage and in 2 patients of advanced stage on a residual mass A complete response was obtained in 77.5% of patients, a partial response in 5% of patients. 14,4% wereprimary refractory and 27% relapsed in a median time of 17 month. Second line treatment was based on DHAOx / DHAP chemotherapy in 16 patients received DHAOxorDHAP as salvage therapy, ICE in08patients were treated by ICE regimen, and GVP (gemcitabine, Vinorelbine, Procarbazine)was used in 4patients. 11 patients required a 3rd or 4th line. 14patients had an autologous stem cell transplantation. 51% of patients presented hematological toxicity, infectious in 56%, pulmonary in 14% and neurological in 3 patients. In amedian follow-up of 38,5 months, the OS and the PFS were respectivelyis 87% and 72%.
Despite the small population sample size, our study has identified the epidemiological, clinical, prognostic and therapeutic profile of patients followed in our department for HL. The treatment was heterogeneous, mainly due to the unavailability of PET-scanner before 2012, and its recent introduction as an interim test to guide adaptation of therapy.