Treatment outcomes in classical Hodgkin lymphoma (HL): 5-year update report from the Brazilian Prospective Registry
Data about HL in developing countries are scarce. In 2009, a HL prospective registry was launched in Brazil.
The first analysis was presented with patients (pts) diagnosed from 2009 to 2014. Here we present an updated analysis with pts diagnosed until 2018 and a median follow-up of 5 years.
A total of 1357 pts with HIV negative classical HL were registered from January 2009 to December, 2018. 28 pts were excluded for various reasons, leaving 1329 pts for this analysis. Median age was 30 y/o (13-90). Females comprised 50%. The median time from onset of symptoms to diagnosis was 6 (0-60) months. 862 (65%) had advanced disease. Stage IVB was present in 28%, and a high-risk IPS score in 40%. Comparing pts included from 2009-2014 and 2015-2018, there was an increase in the use of PET for staging (11% vs 36%, P<.0001) and for end-of-treatment (40% vs 79%, P<.0001). ABVD was the first-line treatment in 94% of pts. 34 pts (2.6%) died during the first treatment. Radiotherapy (RT) was used in 72% of pts with limited, 59% with intermediate, and 28% with advanced disease. There was a reduction in the use of RT (44% vs 35%, P=.002) from 2009-2014 to 2015-2018. This reduction was higher in advanced disease (32% vs 24%, P=0.01). The 5-year progression-free survival (PFS) and 5-year overall survival (OS) were 70% and 86%, respectively. The 5-year PFS in limited, intermediate, and advanced disease were 97%, 82%, and 62% (P<.0001), respectively. The 5-year OS for limited, intermediate and advanced disease were 100%, 94%, and 80% (P<.0001), respectively. The impact of socioeconomic status (SES) on outcomes was analyzed in pts treated with ABVD. The 5-year PFS in higher and lower SES were 75% and 60% (P<.0001). The 5-year OS in higher and lower SES were 90% and 77% (P < 0.0001). The fatality ratio during treatment was 5.0% and 1.1% for lower and higher SES (P<0.0001). After adjustments for potential confounders, lower SES remained independently associated with poorer survival (HR 2.10 [1.52-2.90] for OS and HR 1.58 [1.26-1.99] for PFS).
This analysis confirmed the predominance of advanced disease and high-risk profile pts. There was an increase in the use of PET and a reduction in RT in recent years. We confirmed that the outcomes are 10-15% lower in Brazil than reported in the literature. SES was an independent factor associated with shorter survival.