Abstract P006

Adaptation of a PET-based treatment strategy and outcomes of patients with Advanced Hodgkins Lymphoma in resource constrained settings

Introduction: Outcomes for patients with Hodgkins Lymphoma (HL) have improved owing to the utilization of a PET based treatment strategy. However, implementation of this strategy has its challenges, especially in resource constrained settings.

Methods: This was a retrospective, single center analysis from a tertiary care hospital in India. All patients with newly-diagnosed Stage IIB-IV HL treated between January 2018 and March 2023 were included for analysis. Complete remission (CR) was defined as Deauville Score (DS) 1, 2 or 3 on PET Scan. Criteria for escalation and de-escalation was as per the RATHL study. Follow-up was censored at 31st March, 2024.

Results: Two-forty six patients with newly diagnosed advanced HL were treated at our center in the study period. Median age of the cohort was 32 years (IQR 21-45) and most patients had Stage IV disease (n-115, 46.7%). An interim PET (iPET) was available for only 167 patients (67.9%). One hundred fourteen patients (68.3%) achieved a CR on iPET, while 47 (28.1%), 4 (2.4%) and 2 (1.2%) patients had a partial response, stable disease and progressive disease respectively. De-escalation and escalation of therapy was done for 59.6% (68/114) and 11.8% (6/51) of eligible patients respectively. Treatment response details, including end of therapy response, relapse and death are shown in Table 1. In the De-escalation cohort, patients who did not have therapy de-escalated were more likely to die (10.9% vs 1.4%; p-0.038). The most common cause of death in these patients was therapy related complications. The estimated 4-year Event Free Survival (EFS) and Overall Survival (OS) were statistically significantly better in patients who had therapy de-escalated (p-0.044 and p-0.015 respectively) (Table 1). In the escalation cohort, all patients receiving escalated therapy achieved a CR. Further, no statistically significant difference in estimated 4-year EFS and OS was found between patients who did and did not receive escalated therapy (p-0.237 and p-0.431 respectively); however, this analysis is limited by the small number of patients receiving escalated therapy.

Conclusion: Adaptation of a PET based strategy is low in resource constrained settings, with approximately 2/3rd of the patients getting an iPET done and further, 60% and 12% patients receiving de-escalation and escalation respectively. In our cohort, patients who did not have therapy de-escalated had increased risk of death due to therapy related complications

Authors

Charanpreet Singh, K. S. Lekshmon, Arihant Jain, Alka Khadwal, Amanjit Bal, Radhika Srinivasan, Rajender K Basher, Pankaj Malhotra, Gaurav Prakash