Contributions
Abstract: PB1862
Type: Publication Only
Background
ABVD and escalated BEACOPP are still the standard of care in patients with advanced Hodgkin Lymphoma (HL). The use of escalated BEACOPP gives better disease control but it is associated with more acute and late toxic effects. The identification of patients who require more or less aggressive initial approach remains the main goal for many investigators in the field of HL.
Aims
The aim of this study was to identify among patients with diagnosed advanced HL without large tumor mass, the subgroup which should not be considered for more aggressive approach than ABVD.
Methods
A retrospective study was performed on 149 patients classical HL, diagnosed in the period June 1997-December 2011. All the patients were in clinicil stage III or IV and didn’t have any tumor lesion of 5 cm or more in its longest diameter. The standard of initial care was 6-8 cycles of ABVD followed by radiotherapy. Prognostic relevance of age more than 45 years, gender, CS IV, presence of B symptoms, IPS score, ESR≥50 mm/h, Hgb < 10.5 g/dL, WBC≥15,000mm³ and lymphopenia (lymphocytes <600/mm³ or <8% of WBC count) were examined.
Results
The median age of analysed patients was 37 (range 17-80). The median follow up was 98 months. For the whole group 5-year event free survival (EFS) was 63.1% and 5-year overall survival (OS) was 80.6%. In univariate analysis, worse OS was found in patients older than 45 years (5-year OS 66.7% vs. 87.8%), patients with CS IV (5-year OS 70.2% vs. 87.0%), B symptoms (5-year OS 77.1% vs. 93.4%), IPS≥3 (5-year OS 71.8% vs. 90.1%), ESR≥50 mm/h (5-year OS 75.0% vs. 89.5%), lymphopenia (5-year OS 65.6% vs. 84.6%) (log rank; p=0.001, p=0.006, p=0.040, p=0.003, p=0.007, p=0.010, respectively), while gender, anaemia and leukocytosis didn’t influence OS (log rank; p=0.303, p=0.714, p=0.522, respectively). Worse EFS was found in patients with CS IV (5-year EFS 50.9% vs. 70.7%, kog rank p=0.002), IPS≥3 (5-year EFS 53.8% vs.73.2%, (log rank; p=0.006) and lymphopenia (5-year EFS 50.0% vs. 66.7%, kog rank p=0.025), while age, gender, B symptoms, ESR≥50 mm/h, anemia and leukocytosis didn’t influence EFS (log rank; p=0.0.078, p=0.437, p=0.068, p=0.151, p=0.384, p=0.158, respectively). The multivariate Cox regression analysis identified age more than 45 years, ESR≥50 mm/h and lymphopenia as independent prognostic factors for OS, while only IPS was identified as an independent factor for EFS. Afterwards, we performed survival analysis with aggregate scores of identified negative prognostic factors for OS for each patient. Since there was no difference in OS in intergroup analysis, groups with 2 and 3 negative prognostic factors were merged. Finally, we developed prognostic model for identifying patients at low (0 factors), intermediate (1 factor) and high risk (2-3 factors) for poor outcome (p=0.000). According to this model, in the examined group 34 (22.8%) patients had low, 64 (43.0%) intermediate and 51 (34.2%) high risk for poor outcome, with 5-years OS of 100%, 84.3% and 60.8%, respectively.
Conclusion
Session topic: 17. Hodgkin lymphoma - Clinical
Keyword(s): prognosis, Hodgkin's Lymphoma
Abstract: PB1862
Type: Publication Only
Background
ABVD and escalated BEACOPP are still the standard of care in patients with advanced Hodgkin Lymphoma (HL). The use of escalated BEACOPP gives better disease control but it is associated with more acute and late toxic effects. The identification of patients who require more or less aggressive initial approach remains the main goal for many investigators in the field of HL.
Aims
The aim of this study was to identify among patients with diagnosed advanced HL without large tumor mass, the subgroup which should not be considered for more aggressive approach than ABVD.
Methods
A retrospective study was performed on 149 patients classical HL, diagnosed in the period June 1997-December 2011. All the patients were in clinicil stage III or IV and didn’t have any tumor lesion of 5 cm or more in its longest diameter. The standard of initial care was 6-8 cycles of ABVD followed by radiotherapy. Prognostic relevance of age more than 45 years, gender, CS IV, presence of B symptoms, IPS score, ESR≥50 mm/h, Hgb < 10.5 g/dL, WBC≥15,000mm³ and lymphopenia (lymphocytes <600/mm³ or <8% of WBC count) were examined.
Results
The median age of analysed patients was 37 (range 17-80). The median follow up was 98 months. For the whole group 5-year event free survival (EFS) was 63.1% and 5-year overall survival (OS) was 80.6%. In univariate analysis, worse OS was found in patients older than 45 years (5-year OS 66.7% vs. 87.8%), patients with CS IV (5-year OS 70.2% vs. 87.0%), B symptoms (5-year OS 77.1% vs. 93.4%), IPS≥3 (5-year OS 71.8% vs. 90.1%), ESR≥50 mm/h (5-year OS 75.0% vs. 89.5%), lymphopenia (5-year OS 65.6% vs. 84.6%) (log rank; p=0.001, p=0.006, p=0.040, p=0.003, p=0.007, p=0.010, respectively), while gender, anaemia and leukocytosis didn’t influence OS (log rank; p=0.303, p=0.714, p=0.522, respectively). Worse EFS was found in patients with CS IV (5-year EFS 50.9% vs. 70.7%, kog rank p=0.002), IPS≥3 (5-year EFS 53.8% vs.73.2%, (log rank; p=0.006) and lymphopenia (5-year EFS 50.0% vs. 66.7%, kog rank p=0.025), while age, gender, B symptoms, ESR≥50 mm/h, anemia and leukocytosis didn’t influence EFS (log rank; p=0.0.078, p=0.437, p=0.068, p=0.151, p=0.384, p=0.158, respectively). The multivariate Cox regression analysis identified age more than 45 years, ESR≥50 mm/h and lymphopenia as independent prognostic factors for OS, while only IPS was identified as an independent factor for EFS. Afterwards, we performed survival analysis with aggregate scores of identified negative prognostic factors for OS for each patient. Since there was no difference in OS in intergroup analysis, groups with 2 and 3 negative prognostic factors were merged. Finally, we developed prognostic model for identifying patients at low (0 factors), intermediate (1 factor) and high risk (2-3 factors) for poor outcome (p=0.000). According to this model, in the examined group 34 (22.8%) patients had low, 64 (43.0%) intermediate and 51 (34.2%) high risk for poor outcome, with 5-years OS of 100%, 84.3% and 60.8%, respectively.
Conclusion
Session topic: 17. Hodgkin lymphoma - Clinical
Keyword(s): prognosis, Hodgkin's Lymphoma