Clinical Features and Prognosis Analysis of Hodgkin Lymphoma: A Multicenter Retrospective Study Over a Decade of Patients in China

Clinical features and outcomes of newly diagnosed classical Hodgkin lymphoma patients in Saudi Arabia: a multicenter cohort study

Classical Hodgkin Lymphoma (cHL) is a prominent B-cell neoplasm, that impacts global and Saudi populations. Given limited large-scale studies focusing on HL in Saudi Arabia, this retrospective multicenter cohort study reviewed the characteristics and clinical outcomes of patients with cHL in Saudi Arabia. All adult patients aged 18 years and older newly diagnosed with cHL at three local tertiary care hospitals were included between January 2016 and December 2021. The primary outcome was to identify the patient's clinical features such as histopathology, risk category, disease stage, and favorable and unfavorable risk factors. Other outcomes include the complete response (CR) assessment post the initial chemotherapy, complications post-chemotherapy, time from cHL initial diagnosis to either refractoriness or relapse disease, progression-free survival (PFS), and overall survival (OS) rate, which were considered secondary. Out of 765 screened patients, 498 patients with cHL were included. The cohort had a median age of 30 years. Histopathological analysis revealed that the majority of the patients had nodular sclerosis (80.7%) and were classified as stage IV (44.8%). The predominant chemotherapy regimen administered was ABVD, utilized in 84.9%. The overall response rate was 90.4%, with 85.2% achieving complete remission. After a median follow-up duration of 3.5 years, the OS was 94.9%, and the PFS was 82.1%. Among patients with relapsed or refractory disease, 56 underwent hematopoietic stem cell transplantation as a part of second-line therapy. The overall response rate post-second-line was 80%. Notably, patients who underwent transplantation had a significantly longer median OS compared to those who did not (49.3 vs. 42.8 months; p = 0.04). However, no significant difference in PFS was observed (9.8 vs. 9.4 months; p = 0.32). This national study offers insights into the clinical features and outcomes of cHL patients in Saudi Arabia, demonstrating that ABVD chemotherapy achieves a high overall response rate and complete remission, with favorable survival rates after a median follow-up of 3.5 years. Furthermore, hematopoietic stem cell transplantation improves median overall survival for patients with relapsed or refractory disease, underscoring the need for close monitoring to manage side effects and enhance outcomes.

Identifying barriers to resilience from the perspective of young and middle-aged patients with lymphoma: A qualitative exploration

PURPOSE

This study aimed to understand and identify barriers to resilience in young and middle-aged patients with lymphoma in the context of Chinese culture.

METHODS

A qualitative descriptive study was employed. Face-to-face, semi-structured, and in-depth individual interviews were conducted between May and July 2022. Purposive and differential sampling was used to select eligible participants. Conventional content analysis was used to analyze qualitative data and identify categories and subcategories. This study followed the COREQ checklist.

RESULTS

Twenty patients aged 28-59 years completed the interviews. Three categories involving thirteen subcategories were identified from the interview data: (1) internal barriers-derived from individual cognitive, emotional, behavioral, spiritual, and physical distress, resulting in internal negative constructs, and reducing the motivation to overcome adversity; (2) unbalanced family functioning-families threatened by disease are incapable of maintaining normal functioning and fail to act effectively when facing crises; and (3) absent social support-insufficient or unavailable shielding protection from social support further inhibits resilience among patients with lymphoma.

CONCLUSIONS

This study identified various barriers to the resilience of young and middle-aged patients with lymphoma in the context of Chinese culture. In addition to the patient's internal barriers of resilience, specific family and socio-cultural barriers should also be emphasized by healthcare professionals. Multidisciplinary and family-centered resilience intervention should be developed to help such patients cope with, adapt to the disease, and achieve good psychosocial returns.

Investigating early progression of Hodgkin lymphoma in a two-center analysis

BACKGROUND/PURPOSE

The early progression of disease (POD) of Hodgkin lymphoma (HL) leads to a poor prognosis. To identify risk factors for early POD, this retrospective two-center cohort analysis was conducted.

METHODS

Medical records of HL patients between 1998 and 2020 from two referral centers were reviewed.

RESULTS

Two-hundred and sixty-nine patients were analyzed. The distribution of early vs. advanced stages was 51.1 vs. 48.9%, respectively. The 5-year progression free survival (PFS) was 63%, and the overall survival (OS) was 87% with a median follow-up of 52.0 months. The complete remission (CR) rate was 85.7%. Disease progression or relapsed disease occurred in 33.9% (n = 85) of patients while 17.0% of this cohort had early POD within 12 months of induction therapy. Patients with early POD had a worse median OS than those without (p < 0.001). Failure to achieve post-induction CR and high international prognostic score (IPS, 3-7) were independent risk factors for early POD. Compared with chemotherapy alone, consolidative radiotherapy after induction chemotherapy was associated with a lower risk of early POD (21.3% vs. 6.2%, p = 0.006).

CONCLUSION

High IPS was an independent risk factor for early POD, which was less observed in those with consolidative radiotherapy.

Prognostic Factors for Clinical Outcomes in Patients with Newly Diagnosed Advanced-stage Hodgkin Lymphoma: A Nationwide Retrospective Study

Introduction

While Hodgkin lymphoma (HL) is mostly curable, outcomes for advanced-stage HL remain unsatisfactory. The International Prognostic Score and its modifications were developed to predict HL prognosis; however, more straightforward prognostic factors are needed. This study aimed to identify simpler prognostic factors for advanced-stage newly diagnosed HL (NDHL).

Methods

This retrospective study used the Taiwan National Health Insurance Research Database and the Taiwan Cancer Registry. Patients with advanced-stage NDHL receiving ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or ABVD-like regimens between 2009 and 2016 were enrolled. Cox proportional hazards models were used to identify prognostic factors for the time to next treatment (TTNT) and overall survival (OS). We used the time-dependent area under the receiver operating characteristic curve (AUROC) to evaluate model performance.

Results

The study included 459 patients with advanced-stage NDHL. A bimodal age distribution (peaks 20-44 and >65 years) was observed. Over a median follow-up of 4.7 years, the complete remission and OS rates were 52% and 76%, respectively. Age ≥60 years (adjusted hazard ratio [aHR]: 1.73, 95% confidence interval [CI]: 1.23-2.43), extranodal involvement (1.40, 1.05-1.87), B symptoms (1.53, 1.13-2.06), and Charlson Comorbidity Index (CCI) ≥1 (1.49, 1.08-2.06) were significantly associated with a shorter TTNT. The time-dependent AUROC was .65. With a time-dependent AUROC of .81, age ≥60 years (4.55, 2.90-7.15) and CCI ≥1 (1.86, 1.18-2.91) were risk factors for worse OS.

Conclusion

Older age and more comorbidities were risk factors for an inferior OS in advanced-stage NDHL, while older age, extranodal involvement, B-symptoms, and higher CCI were significantly associated with disease relapse.