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Zawati I, Adouni O, Finetti P, Manai M, Manai M, Gamoudi A, Birnbaum D, Bertucci F, Mezlini A. Adolescents and young adults with classical Hodgkin lymphoma in northern Tunisia: insights from an adult single-institutional study. Cancer Radiother 2020; 24:206-214. [PMID: 32171674 DOI: 10.1016/j.canrad.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to extensively describe the epidemiological, clinical and therapeutic outcomes of adolescents and young adults (AYA) population with classical Hodgkin Lymphoma (cHL). Then, a comparison between AYAs and adults and between the subgroups of AYAs treated with the same adult protocol was accomplished to further inform on optimal therapy approach of choice for adolescent patients. MATERIAL AND METHODS In this mono-centric, retrospective study, we reviewed the medical records. We analyzed 112 consecutive North Tunisian patients, including 66 AYAs (15 to 39 years) and 46 adults (≥40years) affected by cHL treated from 2000 to 2015 at Salah Azaiez Institute. Then, we performed a comparative analysis between AYA and 46 adult patients and a subgroup analysis between adolescents and young adults. All patients were treated according to the national protocol for HL, edited by the Tunisian Society of Hematology. The treatment included chemotherapy and involved-field radiotherapy (RT) at a dose of 20 or 30 Grays (Gy) for responders and 36Gy for non-responders. RESULTS AYA patients presented with adverse features with nodular sclerosis subtype (p=3.88×10-02) and mediastinal mass involvement (p=9.40×10-04). At a median follow-up of 51 and 32 months for AYAs and adults, respectively, no statistical difference in terms of 3 and 5-years overall survival (OS) and event-free survival (EFS) was shown. Using the Kaplan-Meier method, in AYAs, the ABVD regimen has an impact on 3-years EFS (p=4.63×10-02). The 36Gy RT was associated with the best 3-years EFS (p=9.24×10-03). Besides, AYA patients with advanced-stage had the worst 3-years OS (76%) (p=2.41×10-02). Although the adolescents and young adults shared similar clinical presentation, we noted that the adolescent group had the worst 3-years EFS (48%), but the best 3-years OS (91%). We identified 15% of primary refractory patients and a rate of toxicity of 5.3% in AYA. CONCLUSION The treatment approach used is well tolerated by adult patients. However, the AYA patients and particularly adolescent subgroup had more advanced disease at diagnosis and should be treated more intensively in dedicated units. RT dose<36Gy and ABVD chemotherapy were associated with lower EFS in this population.
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Affiliation(s)
- I Zawati
- Department of Immunohistocytology, Salah Azaiez Institute, 1006 Tunis, Tunisia; Department of Biology, Mycology, Pathologies and Biomarkers Laboratory (LR16ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Ariana, Tunisia.
| | - O Adouni
- Department of Immunohistocytology, Salah Azaiez Institute, 1006 Tunis, Tunisia; Department of Biology, Mycology, Pathologies and Biomarkers Laboratory (LR16ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Ariana, Tunisia
| | - P Finetti
- Predictive Oncology Laboratory, Cancer Research Center of Marseille, Aix Marseille University, 13009 Marseille, Tunisia
| | - Ma Manai
- Department of Immunohistocytology, Salah Azaiez Institute, 1006 Tunis, Tunisia; Predictive Oncology Laboratory, Cancer Research Center of Marseille, Aix Marseille University, 13009 Marseille, Tunisia; Human Genetics Laboratory (LR99ES10), Faculty of Medicine of Tunis, University of Tunis, El Manar, 2092 Tunis, Tunisia
| | - M Manai
- Department of Biology, Mycology, Pathologies and Biomarkers Laboratory (LR16ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Ariana, Tunisia
| | - A Gamoudi
- Department of Immunohistocytology, Salah Azaiez Institute, 1006 Tunis, Tunisia
| | - D Birnbaum
- Predictive Oncology Laboratory, Cancer Research Center of Marseille, Aix Marseille University, 13009 Marseille, Tunisia
| | - F Bertucci
- Predictive Oncology Laboratory, Cancer Research Center of Marseille, Aix Marseille University, 13009 Marseille, Tunisia; Department of Medical Oncology, Paoli-Calmettes Institute, 13009 Marseille, France; Training and Research Unit of Medicine, Aix Marseille University, 13009 Marseille, France
| | - A Mezlini
- Department of Medical Oncology, Salah Azaiez Institute, 1006 Tunis, Tunisia
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