Introduction: Although Hodgkin lymphoma (HL) can be cured in the majority of patients, some patients relapsed, or died due to the disease itself, second malignancies or organ failure caused by previous chemo-radiotherapy. Recently, monoclonal antibodies (mAb) targeting CD30 or PD-1 have been incorporated in the frontline treatment of patients of HL with excellent results. However, it is not clear which patients might benefit more chemo-immunotherapy rather than a traditional chemo-radiotherapy approach
Aim: In this study we aimed at identify risk factor associated with shorter survival in patients with classical Hodgkin lymphoma
Methods: We collected patients with HL followed at Padova university hospital from 1994 till 2020. Overall survival was calculated as months from diagnosis to death (event) or last known follow-up (censured). Survival curves were compared by the Log-rank test. P values <0.05 were considered as statistically significant
Results: Among the 383 classical HL, 313 had enough data and were included in this study. The media age at diagnosis was 37+16 years, 27% of patients were older than 45 years, 51% were male, 74% had a nodular sclerosis HL subtype (NSHL), 21% were at stage IV, 32% a bulky disease and 51% denied B symptoms. Ninety-seven % of patients were treated with curative intent with ABVD, ABVD-like or BEACOPP protocols. After a median follow-up of 77 months, 21% of patients relapsed and 9% died. On univariate analysis male gender, age >45 years, not NSHL subtype and stage IV were associated with a shorter OS (Tab 1). However only age >45 years, not NSHL subtype, and stage 4 maintained the independent significance in multivariate analysis (Table 1). Remarkably, a PET-adapted strategy allows to improve the progression free survival of our patients but not the OS. By using the hard ratio half values, we assigned 1 point to male gender and 2 points to age >45 years and stage IV (Tab. 1). Combing these variables, 60% had a 0-1 point (low-risk), 31.5% 2-3 points (int. risk) and 8.5% >=4 points (high-risk). The OS decreased increasing the point scores. The 10-year OS was 94%, 79% and 67% for patients at low, intermediate and high-risk (Fig. 1). Patients at high-risk had almost 10 and 3-fold risk of death than low and intermediate risk patients
Conclusions: Despite the optimal outcome of HL with a chemo-radiotherapy approach, novel strategies incorporating anti-CD30 and/or anti-PD-1 mAb are need, in particular for adult stage IV patients.