CONDITIONAL RELATIVE SURVIVAL IN ADULT PATIENTS WITH CLASSICAL HODGKIN LYMPHOMA: A NATIONWIDE, POPULATION-BASED STUDY IN THE NETHERLANDS, 1989-2017
Author(s): ,
Julia Driessen
Affiliations:
Department of Hematology,Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam,Amsterdam,Netherlands
,
Otto Visser
Affiliations:
Department of Registration,Netherlands Comprehensive Cancer Organisation (IKNL),Utrecht,Netherlands
,
Josée M. Zijlstra
Affiliations:
Department of Hematology,Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam,Amsterdam,Netherlands
,
Eduardus F.M. Posthuma
Affiliations:
Department of Internal Medicine,Reinier de Graaf Group,Delft,Netherlands;Department of Hematology,Leiden University Medical Center,Leiden,Netherlands
,
Pieternella J. Lugtenburg
Affiliations:
Department of Hematology,Erasmus MC Cancer Institute,Rotterdam,Netherlands
,
Wouter J. Plattel
Affiliations:
Department of Hematology,University Medical Center Groningen, University of Groningen,Groningen,Netherlands
,
Marie José Kersten
Affiliations:
Department of Hematology,Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam,Amsterdam,Netherlands
Avinash G. Dinmohamed
Affiliations:
Department of Research,Netherlands Comprehensive Cancer Organisation (IKNL),Utrecht,Netherlands;Department of Public Health,Erasmus MC, Erasmus University Medical Center,Rotterdam,Netherlands
EHA Library. Driessen J. 06/12/20; 295041; S221
Julia Driessen
Julia Driessen
Contributions
Abstract

Abstract: S221

Type: Oral Presentation

Presentation during EHA25: All oral abstract presentations will be made available on the on-demand Virtual Congress platform as of Friday, June 12 at 08:30 CEST and will be accessible until October 15, 2020.

Session title: Hodgkin lymphoma - Clinical

Background

Major advances in therapy over the past decades transformed classical Hodgkin lymphoma (cHL) from a lethal into a largely curable malignancy. Indeed, survival rates in cHL are generally high. However, it remains ill-defined from which time after diagnosis cHL patients across various subgroups of age and stage have a life expectancy that is similar to comparable groups from the general population.

Aims

Here, we estimated conditional relative survival (CRS), which is the survival estimate for patients who have survived from a specified time since diagnosis, corrected for the life expectancy in the general population, among adult cHL patients diagnosed in the Netherlands.

 

Methods

We selected all adult (≥18 years) cHL patients diagnosed between 1989-2017 from the nationwide Netherlands Cancer Registry, with survival follow-up until January 1, 2019. We calculated 5-year CRS from diagnosis and for each additional year survived up to 10 years post-diagnosis. CRS was estimated for the overall cohort and stratified by sex, disease stage at diagnosis (I/II and III/IV), calendar period of diagnosis (1989-1999, 2000-2009, and 2010-2017), and age at diagnosis (18-29, 30-39, 40-49, 50-59, and ≥60 years). Excess mortality (EM), as compared to a matched group (by age, sex, and calendar year) from the general population, is considered low and minimal when 5-year CRS ranges between 90-95% and exceeds 95%, respectively.

Results

We included 9,989 adult cHL patients (median age, 39 years; 43% females; 38% stage III/IV) in our analysis. Five-year CRS from diagnosis was 83% for the overall cohort and increased up to 92% at 10 years post-diagnosis (Fig 1A). There was no significant difference in 5-year CRS between males and females throughout the follow-up period (Fig 1B). Five-year CRS from diagnosis was lower with advanced stage (Fig 1C). However, the stage differential in 5-year CRS from diagnosis ultimately diminished at 10 years post-diagnosis. Of note, the increase in 5-year CRS was most marked among stage III/IV patients compared to stage I/II patients. Five-year CRS improved over time up to 5 years post-diagnosis across the epochs studied (Fig 1D). Thereafter, 5-year CRS remained stable. Patients up to age 50 experienced comparatively low EM in the first five years following diagnosis (Fig 1E), which gradually decreased over time, ranging between 93-98% at 10 years post-diagnosis. Five-year CRS in patients aged 50-59 years initially increased up to 91% after 5 years post-diagnosis, but declined afterward. Five-year CRS from diagnosis in patients aged ≥60 years increased from 54% to 69% at one year post-diagnosis. Thereafter, 5-year CRS remained close to 65-70% up to 10 years post-diagnosis.

Conclusion

Overall, 5-year CRS increased with each year survived after diagnosis, with the most marked increases for patients who survived the first 3 years post-diagnosis, especially in stage III/IV patients. This finding suggests that most patients who survive after this time have low EM. Patients up to age 50 had low to minimal EM over the follow-up period, suggesting that their survival expectations are considered similar to comparable groups from the general population. Age 50 or above, however, remains an important prognostic factor over time, because it was associated with persistent EM that could be ascribed to late treatment-related toxicity, secondary malignancies, or late relapses. Our study findings can be used to plan tailored surveillance and follow-up activities.

Session topic: 17. Hodgkin lymphoma - Clinical

Keyword(s): Epidemiology, Hodgkin's lymphoma, Population, Survival

Abstract: S221

Type: Oral Presentation

Presentation during EHA25: All oral abstract presentations will be made available on the on-demand Virtual Congress platform as of Friday, June 12 at 08:30 CEST and will be accessible until October 15, 2020.

Session title: Hodgkin lymphoma - Clinical

Background

Major advances in therapy over the past decades transformed classical Hodgkin lymphoma (cHL) from a lethal into a largely curable malignancy. Indeed, survival rates in cHL are generally high. However, it remains ill-defined from which time after diagnosis cHL patients across various subgroups of age and stage have a life expectancy that is similar to comparable groups from the general population.

Aims

Here, we estimated conditional relative survival (CRS), which is the survival estimate for patients who have survived from a specified time since diagnosis, corrected for the life expectancy in the general population, among adult cHL patients diagnosed in the Netherlands.

 

Methods

We selected all adult (≥18 years) cHL patients diagnosed between 1989-2017 from the nationwide Netherlands Cancer Registry, with survival follow-up until January 1, 2019. We calculated 5-year CRS from diagnosis and for each additional year survived up to 10 years post-diagnosis. CRS was estimated for the overall cohort and stratified by sex, disease stage at diagnosis (I/II and III/IV), calendar period of diagnosis (1989-1999, 2000-2009, and 2010-2017), and age at diagnosis (18-29, 30-39, 40-49, 50-59, and ≥60 years). Excess mortality (EM), as compared to a matched group (by age, sex, and calendar year) from the general population, is considered low and minimal when 5-year CRS ranges between 90-95% and exceeds 95%, respectively.

Results

We included 9,989 adult cHL patients (median age, 39 years; 43% females; 38% stage III/IV) in our analysis. Five-year CRS from diagnosis was 83% for the overall cohort and increased up to 92% at 10 years post-diagnosis (Fig 1A). There was no significant difference in 5-year CRS between males and females throughout the follow-up period (Fig 1B). Five-year CRS from diagnosis was lower with advanced stage (Fig 1C). However, the stage differential in 5-year CRS from diagnosis ultimately diminished at 10 years post-diagnosis. Of note, the increase in 5-year CRS was most marked among stage III/IV patients compared to stage I/II patients. Five-year CRS improved over time up to 5 years post-diagnosis across the epochs studied (Fig 1D). Thereafter, 5-year CRS remained stable. Patients up to age 50 experienced comparatively low EM in the first five years following diagnosis (Fig 1E), which gradually decreased over time, ranging between 93-98% at 10 years post-diagnosis. Five-year CRS in patients aged 50-59 years initially increased up to 91% after 5 years post-diagnosis, but declined afterward. Five-year CRS from diagnosis in patients aged ≥60 years increased from 54% to 69% at one year post-diagnosis. Thereafter, 5-year CRS remained close to 65-70% up to 10 years post-diagnosis.

Conclusion

Overall, 5-year CRS increased with each year survived after diagnosis, with the most marked increases for patients who survived the first 3 years post-diagnosis, especially in stage III/IV patients. This finding suggests that most patients who survive after this time have low EM. Patients up to age 50 had low to minimal EM over the follow-up period, suggesting that their survival expectations are considered similar to comparable groups from the general population. Age 50 or above, however, remains an important prognostic factor over time, because it was associated with persistent EM that could be ascribed to late treatment-related toxicity, secondary malignancies, or late relapses. Our study findings can be used to plan tailored surveillance and follow-up activities.

Session topic: 17. Hodgkin lymphoma - Clinical

Keyword(s): Epidemiology, Hodgkin's lymphoma, Population, Survival

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