Prognostic Factors and Outcomes of Early-Stage Hodgkin's Lymphoma: Multi-Institutional Data From South India.

IF 0.7 4区医学 Q4 HEMATOLOGY

Indian Journal of Hematology and Blood Transfusion Pub Date : 2024-04-01 Epub Date: 2023-08-30 DOI:10.1007/s12288-023-01692-9

Lakshmi Sandhya Singuluri, Perumal Kalaiyarasi Jayachandran, Luxitaa Goenka, Praveen Kumar Shenoy, Krishna Kumar Rathnam, Arun Seshachalam, Nikita Mehra, Mummoorthy Ram Kumar, Murugan Mangai Suseela, Vineetha Raghavan, Chandran K Nair, Biswajit Dubashi, Manikandan Dhanushkodi, Prasanth Ganesan

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Abstract

Early-stage Hodgkin's lymphoma (ESHL) is highly curable, usually with a combination of chemotherapy and radiation. Real-world data may show differences in survival and prognostic factors when compared to clinical trials. There is limited published literature on ESHL from India. The data on the baseline characters, treatment, and outcomes of patients with ESHL (stage IA, IB, and IIA) were obtained from five institutions' medical records and entered in a common database. Event-free survival (EFS) and overall survival (OS) were estimated using the Kaplan Meier method, and cox-regression analysis was used to identify prognostic factors. There were 258 patients [median age was 37 (18-75) years; [males:160 (62%); stage I: 41%; B symptoms: 17 (6%); bulky disease:19 (15%)] treated between 2000 and 2020 who were evaluable. The common chemotherapies used were ABVD [N = 180 (70%)], COPP-ABVD hybrid [N = 52 (21%)], and COPP [N = 14 (5%)]. Median number of cycles were 4 (2-8) and 93 (47%) received radiation at end of treatment. After a median follow-up of 60 months, the 5 years EFS was 87% and OS was 92%. On multivariate analysis, the following factors adversely affected the EFS: Male gender [hazard ratio (HR) = 2.23, P = 0.02] and Hemoglobin < 10.5g/dL [hazard ration (HR) = 2.20, P = 0.02], and the following adversely affected the OS: Hemoglobin < 10.5g/dL [hazard ratio (HR) = 4.05, P = 0.001], Male gender [hazard ratio (HR) = 3.59, P = 0.004], Stage 2 [hazard ratio (HR) = 2.65, P = 0.002] and ECOG PS (2-3) [hazard ratio (HR) = 3.35, P = 0.01]. Using the hemoglobin, stage and gender a 3-item prognostic score could identify patients with very good outcomes (score 0; 5 years OS:100%) and poor outcomes (score 3; 5 years OS; 49%). This is one of the first multi-center real-world data exclusively focusing on ESHL from India. Though the survival of the entire population was good, there are subsets of patients who have poor outcomes, which may be identified using simple parameters. These parameters need validation in a larger dataset.

Supplementary information: The online version contains supplementary material available at 10.1007/s12288-023-01692-9.

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早期霍奇金淋巴瘤的预后因素和预后：来自南印度的多机构数据

早期霍奇金淋巴瘤（ESHL）治愈率很高，通常采用化疗和放疗相结合的方法。与临床试验相比，真实世界的数据可能会显示出生存率和预后因素的差异。印度发表的有关 ESHL 的文献十分有限。我们从五家医疗机构的病历中获取了ESHL（IA、IB和IIA期）患者的基线特征、治疗和预后数据，并将其输入一个共同的数据库。采用卡普兰-梅耶法估算无事件生存期（EFS）和总生存期（OS），并通过柯克斯回归分析确定预后因素。2000年至2020年间接受治疗的258名患者[中位年龄为37（18-75）岁；[男性：160（62%）；I期：41%；B症状：17（6%）；大块疾病：19（15%）]均可进行评估。常用的化疗方法有 ABVD [N = 180（70%）]、COPP-ABVD 混合疗法 [N = 52（21%）] 和 COPP [N = 14（5%）]。中位治疗周期数为 4 个（2-8），93 例（47%）患者在治疗结束时接受了放射治疗。中位随访时间为 60 个月，5 年 EFS 为 87%，OS 为 92%。经多变量分析，以下因素对 EFS 有不利影响：男性[危险比（HR）= 2.23，P = 0.02]和血红蛋白 P = 0.02]，以下因素对 OS 有不利影响：血红蛋白 P = 0.001]、男性[危险比（HR）= 3.59，P = 0.004]、2 期[危险比（HR）= 2.65，P = 0.002]和 ECOG PS（2-3）[危险比（HR）= 3.35，P = 0.01]。利用血红蛋白、分期和性别进行 3 项预后评分，可识别出预后非常好（0 分；5 年 OS：100%）和预后较差（3 分；5 年 OS：49%）的患者。这是印度首个专门针对 ESHL 的多中心真实世界数据。虽然整个人群的生存状况良好，但仍有部分患者的预后较差，这可以通过简单的参数来识别。这些参数需要在更大的数据集中进行验证：在线版本包含补充材料，可在 10.1007/s12288-023-01692-9 上获取。

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来源期刊

Indian Journal of Hematology and Blood Transfusion HEMATOLOGY-

CiteScore

1.70

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Indian Journal of Hematology and Blood Transfusion is a medium for propagating and exchanging ideas within the medical community. It publishes peer-reviewed articles on a variety of aspects of clinical hematology, laboratory hematology and hemato-oncology. The journal exists to encourage scientific investigation in the study of blood in health and in disease; to promote and foster the exchange and diffusion of knowledge relating to blood and blood-forming tissues; and to provide a forum for discussion of hematological subjects on a national scale. The Journal is the official publication of The Indian Society of Hematology & Blood Transfusion.