Abstract: PB1562

Type: Publication Only

Session title: Hodgkin lymphoma - Clinical

Background
Bulky mediastinal disease (BMD) is one of the prognostic factors in Hodgkin lymphoma (HL) usually associated with a poor prognosis. In order to improve treatment results for patients with BMD, the Tunisian group changed the national protocol based on ABVD (MDH2002)to BEACOPP escalated regimen(MDH2008 in 2008,then MDH2015 in 2015). 

Aims

Our study aims to evaluate and compare the therapeutic results of these protocols in these patients.

Methods

Our study is retrospective interesting 71 newly diagnosed HL adults (<60 years old) with BMD (MTI ≥0.35) treated between January 2002 and June 2020 at the hematology department of Hedi Chaker hospital in Sfax, Tunisia with different versions of national protocols. A total of 20 patients were enrolled from January 2002 to December 2007 with the MDH2002. It is based on the use of the ABVD regimen: 6 cycles for unfavorable early stagesfollowed by involved field radiation therapy (IFRT), and 8 cycles for advanced stages followed by consolidative radiation therapy if there is a residual mass. The MDH2008 and MDH2015 protocol sare rather based on staging these patients in advanced stages and treating themwith intensive chemotherapy: the BEACOPP escalated regimen. Early assessment of response based on scanography is recommended after two cycles and de-escalation to ABVD is favored if the response is ≥75%(according to Cheson’s criteria).MDH2015 differs from MDH2008 by reducing the number of cycles to six instead of eight in order to decrease toxicity. Our review determines therapeutic responses, the overall survival (OS), event-free survival (EFS), and factors forecast which influenced these survivals. It aims to compare these survivals using the ABVD regimen (MDH2002=P1) and BEACOPP regimen (MDH2008 and 2015 = P2).

Results

Median age at presentation was 24 years (range 16-51 years). The study included 44 females and 27 males. Forty-four percent(44 %) of patients presented with advanced disease. B-symptoms, more than three sites of involvement, and Bulky tumor were respectively recorded in 75%, 39.4%, and 43.7% of cases.The CR/CRu rate was 69% at the end of treatment (55% with P1 versus 74.5% with P2). PR was 11.3%(5% vs 13.7%). 19.7% of patients did not respond to treatment (40% vs 11.7%) either by a stable disease, progressive disease,or death before the end of chemotherapy.The difference in response between P1 and P2 was significant (p=0.023).With a median follow-up of 72months (range 1-232 months),3- year and 6-year OS rates were respectively 79.6% (65% vs 85.4%) and77.9% (60% vs 85%) with a statistically significant difference between the two groups (p=0.039). Median EFS was 40months. Three-year EFS was 59.7% (45% vs 65.6%), (p=0.01).

Conclusion
Our results show that the BEACOPP regimen is superior to ABVD for initial disease control and prolonged time to relapse in the treatment of patientswith BMD as described in the literature. However, it noted that BMD stills a poor prognosis factor for OS and EFS comparing to other cases of HL without BMD.

Keyword(s): Hodgkin's disease, Prognostic factor, Treatment