Outcomes of first-line treatment (FL) of classical Hodgkin lymphoma (cHL) in Argentina: a real life multicenter retrospective study
Estimated incidence of cHL in Argentina is 842 cases/year (Globocan 2018).There is no local data regarding response rates (RR) to FL. GATLA (Grupo Argentino de Tratamiento de Leucemia Aguda) reported 3 year-progression free survival (PFS) of 90% and overall survival (OS) of 98%.
To learn the RR, PFS and OS after FL of cHL in public (PuI) and private institutions (PrI) in Argentina.
Retrospective analysis of patients (pts) with cHL diagnosis from 1-2008 to 2-2019 and available follow up (FU) data. Descriptive statistics were used for clinical and histological variables. Survival rates were estimated with Kaplan-Meier and variables compared with log-rank test.
498 pts with cHL from 7 PuI and PrI were analyzed. Median FU: 37.4 months (m). Pts characteristics: Table 1. Median time to FL initiation: 22 days, shorter in PrI (p=0.0027). 96.5% received ABVD as FL. 17.1% required dose modifications or delays. Complete remission (CR) rate: 83.4% (higher in PrI) and partial remission (PR): 6.3%. 85.4% had negative end of treatment (EOT) PET. 70% had an interim PET (i-PET) exam, 83.8% achieved metabolic CR but only 15.5% were treated with PET-adapted strategies (6.5% deescalated to AVD). Anemia, neutropenia and thrombocytopenia were found in 28.5%, 56.4% and 7.2%, respectively. Non-hematologic toxicities were observed in 28.6% (lung toxicity in 41 pts). 51 pts had primary refractory disease and 69 relapsed. 65 pts died, due to lymphoma progression (34) and toxicity (31). 2 and 5 year OS rate: 91% and 85%. There was no difference in OS between PrI and PuI (p=0.27). 5 year PFS rate: 76%. Every day of delay in initiating FL increased 0.89 (CI95% 0.6-1.8) the risk of PR or progressive disease after FL. On univariate analysis: women, age <60, non-bulky disease, normal ESR, stage I-III, favorable prognostic disease, Charlson score <3 and absence of extranodal were associated with better outcomes. On multivariate analysis Charlson score and EOT PET scan remained independent predictors of OS with HR of 1.2 (CI95%1.1-1.7; p=0.001) and 2.3 (CI95% 1.7-3.2; p<0.0001), respectively.
This is one of the largest retrospective cohorts reported in cHL. ABVD is the FL regimen of choice in our country. It was well tolerated but not exempt from toxicity. Despite wide use of i-PET, only 15.5% received PET-guided treatment. The use of response-adapted strategies in our population should be strongly considered.