Abstract P114

Early Progression of Disease Predicts Poor Survival in Patients with Classic Hodgkin Lymphoma: Czech Hodgkin Lymphoma Study Group analysis

Background: Early progression within 24 months (POD24) of initial immunochemotherapy is associated with poor survival in non-Hodgkin lymphomas, identifying a high-risk subgroup with different lymphoma biology. Little is known about the incidence and impact of POD24 in Hodgkin lymphoma patients (pts), as current prognostic systems (aHIPI) use longer (5-year) survival endpoints.

Methods: We analyzed pts with classic HL (cHL) treated at two academic institutions: Olomouc (training-T) and Hradec Králové (validation-V), enrolled in the Czech Hodgkin Lymphoma Study Group database (NCT06263530) between 2000-2020. An early event was defined as progression, relapse, or death related to progressive HL within 24 months after the date of diagnosis. Overall survival (OS) and progression-free survival (PFS) were calculated from the date of diagnosis. To evaluate the association between early POD and OS from a risk-defining event, survival was calculated from the time of POD for early progressors (POD24) or from 2 years after diagnosis for the reference group (noPOD24). Patients with early death (<24 months) without recorded disease progression were excluded from the POD24 analysis.

Results: The analyzed cohort consisted of 906 pts (418 in T and 488 in the V cohort). There was no significant difference in terms of age (median age 35 vs 34 years, p=0.52), clinical stages distribution (CS III/IV in 41.6% vs 44.8%, p=0.64), induction therapy given (BEACOPP in 57% vs 52%, p=ns), and treatment response (CRR 88.4% vs 90.7%, p=0.52). There was a significant difference in the cHL subtypes distribution with MC in 35% vs 6% and NS in 53% vs 82% in the T and V cohorts, respectively (p=0.01). After a median follow-up of surviving pts of 118 vs 126 months (p=0.07), 72 pts relapsed or progressed in the T group and 62 in the V group. The POD24-event occurred in 36 pts (8.9%) in the T group and 38 pts (8.1%) in the V group. There was no difference in terms of PFS (p=0.1) or OS (p=0.88) between the T and V groups. The 5-year OS since the risk-defining event was 48.1% and 34% vs 94.2% and 93.2% in the POD-T, POD-V, noPOD-T, and noPOD-V groups, respectively (Fig 1).

Conclusions: Early progression of the disease is rare but catastrophic event in HL, resulting in high risk of death. Further exploration is ongoing to contextualize POD24 with prognostic indices (aHIPI), PET metrics, and ctDNA analyses. Acknowledgements: Supported by MH CZ – DRO (FNOL, 00098892), AZV NU22-03-00182.