Contributions
Abstract: EP780
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
Acceptance of de-escalating therapy in the REAL world has been slow due to the limited access and cost of PET scans.
Aims
To audit Hodgkin Lymphoma (HL) characteristics and 5-year outcomes in a single tertiary cancer center.
To study the outcomes of patients who underwent PET directed therapy compared to patients who received standard 6 cycles of ABVD therapy
Methods
1396 lymphomas (>18 years) were entered in the Onco-Collect data base of patients receiving 1st line treatment from May 2011 to December 2017. Demography, Clinical features, staging, prognostic stratification, and first line treatment response and outcomes of 280 HL patients treated at a tertiary center have been analyzed. A PET directed approach was followed for patients receiving ABVD therapy. Early stage (1 and 2) patients received 4 or 6 cycles and in Late stage (3 and 4) received ABVD x 6 cycles or ABVD followed by AVD in patients who were in complete remission after 2 cycles.
Overall Response (OR) rates, and DFS were evaluated for patients receiving 1st line treatment, and these patients were followed till September 2020.
Results
HL formed 20% of the lymphoma cohort receiving 1st line treatment at our Institute. The median age was 37 years at presentation and age distribution was 53%, 39% and 8% respectively for <40 years, between 40 to 65 years and ≥ 65 years of age. Gender ratio for male to female was 2.18:1. 41% Patients presented in early stage [I & II], and 58% in late stage [III &IV].
Most common protocol used was standard ABVD in 90% patients. The OR rate (CR +PR+ SD) was 89.2%, and the progression on treatment 6.8%. With a median follow-up of 48 months, the DFS is 79.36%. DFS for the patients above 65 years was 62% at 5 years and for those below 65 years was 76% (p=0.052). The 5-year DFS for stage 1, 2, 3 and 4 was 94.73%, 85.57%, 78.81% and 67.78% respectively (p=0.017). Patients with early-stage disease receiving 6 cycles (#55) had similar outcomes at 5 years compared to patients receiving 4 cycles +/- radiotherapy (#34). Outcomes for late-stage disease, after the omission of bleomycin after 2 cycles in patients achieving PET CR was comparable to patients receiving 6 cycles of ABVD
Conclusion
HL presents at a median age of 37 years in the adults ≥18 years and the bimodal peak is not seen in our population. The OR to treatment is nearly 90%, with CR in 76% patients. Our initial experience with de-escalation of therapy have yielded encouraging results in the REAL world setting. Long term outcomes for Stage 3 & 4, can be improved with chemotherapy escalation strategies or use of targeted molecules and immune therapy.
Keyword(s):
Abstract: EP780
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
Acceptance of de-escalating therapy in the REAL world has been slow due to the limited access and cost of PET scans.
Aims
To audit Hodgkin Lymphoma (HL) characteristics and 5-year outcomes in a single tertiary cancer center.
To study the outcomes of patients who underwent PET directed therapy compared to patients who received standard 6 cycles of ABVD therapy
Methods
1396 lymphomas (>18 years) were entered in the Onco-Collect data base of patients receiving 1st line treatment from May 2011 to December 2017. Demography, Clinical features, staging, prognostic stratification, and first line treatment response and outcomes of 280 HL patients treated at a tertiary center have been analyzed. A PET directed approach was followed for patients receiving ABVD therapy. Early stage (1 and 2) patients received 4 or 6 cycles and in Late stage (3 and 4) received ABVD x 6 cycles or ABVD followed by AVD in patients who were in complete remission after 2 cycles.
Overall Response (OR) rates, and DFS were evaluated for patients receiving 1st line treatment, and these patients were followed till September 2020.
Results
HL formed 20% of the lymphoma cohort receiving 1st line treatment at our Institute. The median age was 37 years at presentation and age distribution was 53%, 39% and 8% respectively for <40 years, between 40 to 65 years and ≥ 65 years of age. Gender ratio for male to female was 2.18:1. 41% Patients presented in early stage [I & II], and 58% in late stage [III &IV].
Most common protocol used was standard ABVD in 90% patients. The OR rate (CR +PR+ SD) was 89.2%, and the progression on treatment 6.8%. With a median follow-up of 48 months, the DFS is 79.36%. DFS for the patients above 65 years was 62% at 5 years and for those below 65 years was 76% (p=0.052). The 5-year DFS for stage 1, 2, 3 and 4 was 94.73%, 85.57%, 78.81% and 67.78% respectively (p=0.017). Patients with early-stage disease receiving 6 cycles (#55) had similar outcomes at 5 years compared to patients receiving 4 cycles +/- radiotherapy (#34). Outcomes for late-stage disease, after the omission of bleomycin after 2 cycles in patients achieving PET CR was comparable to patients receiving 6 cycles of ABVD
Conclusion
HL presents at a median age of 37 years in the adults ≥18 years and the bimodal peak is not seen in our population. The OR to treatment is nearly 90%, with CR in 76% patients. Our initial experience with de-escalation of therapy have yielded encouraging results in the REAL world setting. Long term outcomes for Stage 3 & 4, can be improved with chemotherapy escalation strategies or use of targeted molecules and immune therapy.
Keyword(s):