Original Article

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Blood Res 2019; 54(3):

Published online September 30, 2019

https://doi.org/10.5045/br.2019.54.3.210

© The Korean Society of Hematology

Clinical features and treatment outcomes of Hodgkin lymphoma: A retrospective review in a Malaysian tertiary hospital

Yang Liang Boo1, Helen Siew Yean Ting1, Diana Fui Sing Yap2, See Guan Toh1, Soo Min Lim1

1Department of Haematology, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, 2Department of Pharmacy, Hospital Enche’ Besar Hajjah Khalsom, Ministry of Health Malaysia, Kluang, Johor, Malaysia

Correspondence to : Yang Liang Boo, M.D.
Department of Haematology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
E-mail: coolrontin@gmail.com

Received: June 13, 2019; Revised: July 7, 2019; Accepted: August 8, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Classical Hodgkin lymphoma (cHL) is a clinicopathologically unique, aggressive lymphoma arising from germinal center B-cells and is one of the most curable hematological malignancies. This study aimed to determine the clinical course, treatment regimens, response rates, and survival data of patients diagnosed with cHL in a tertiary center.

Methods

A retrospective review was conducted to include patients with a diagnosis of cHL from 2013 to 2017. Data of demographic and clinical characteristics, treatment regimens, and outcomes were collected and analyzed.

Results

We recruited 94 patients with a median age of 27.0 [interquartile range (IQR), 12] years. Most of the patients were male (61.7%) and 73.4% were ethnic Malay. Nodular sclerosis was the most common histology (77.6%), followed by mixed cellularity (6.4%) and others (16%). The median follow-up time was 28.0 (IQR, 32) months. All patients received chemotherapy but only 13.8% received radiotherapy as consolidation. The doxorubicin-bleomycin-vinblastine-dacarbazine regimen was the most common (85.1%), followed by the escalated bleomycin-etoposide-doxorubicin-cyclophosphamide-vincristineprednisolone-procarbazine regimen (14.9%). Following treatment, 76.1% of patients achieved complete response. The 2-year overall survival (OS) and progression-free survival (PFS) of the entire cohort were 96.5% and 71.1%, respectively. The 2-year OS and PFS for advanced-stage disease were 93.9% and 62.8%, compared to 100% and 82.7% for early-stage disease, respectively (P=0.252 and P=0.052, respectively).

Conclusion

This study provides insight into the clinical presentation and treatment outcomes among patients with cHL in Malaysia. A longer study duration is required to identify OS and PFS benefits and treatment-related complications for different chemotherapeutic regimens.

Keywords Hodgkin lymphoma, Clinical features, Treatment outcomes, Malaysia

Article

Original Article

Blood Res 2019; 54(3): 210-217

Published online September 30, 2019 https://doi.org/10.5045/br.2019.54.3.210

Copyright © The Korean Society of Hematology.

Clinical features and treatment outcomes of Hodgkin lymphoma: A retrospective review in a Malaysian tertiary hospital

Yang Liang Boo1, Helen Siew Yean Ting1, Diana Fui Sing Yap2, See Guan Toh1, Soo Min Lim1

1Department of Haematology, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, 2Department of Pharmacy, Hospital Enche’ Besar Hajjah Khalsom, Ministry of Health Malaysia, Kluang, Johor, Malaysia

Correspondence to:Yang Liang Boo, M.D.
Department of Haematology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
E-mail: coolrontin@gmail.com

Received: June 13, 2019; Revised: July 7, 2019; Accepted: August 8, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Classical Hodgkin lymphoma (cHL) is a clinicopathologically unique, aggressive lymphoma arising from germinal center B-cells and is one of the most curable hematological malignancies. This study aimed to determine the clinical course, treatment regimens, response rates, and survival data of patients diagnosed with cHL in a tertiary center.

Methods

A retrospective review was conducted to include patients with a diagnosis of cHL from 2013 to 2017. Data of demographic and clinical characteristics, treatment regimens, and outcomes were collected and analyzed.

Results

We recruited 94 patients with a median age of 27.0 [interquartile range (IQR), 12] years. Most of the patients were male (61.7%) and 73.4% were ethnic Malay. Nodular sclerosis was the most common histology (77.6%), followed by mixed cellularity (6.4%) and others (16%). The median follow-up time was 28.0 (IQR, 32) months. All patients received chemotherapy but only 13.8% received radiotherapy as consolidation. The doxorubicin-bleomycin-vinblastine-dacarbazine regimen was the most common (85.1%), followed by the escalated bleomycin-etoposide-doxorubicin-cyclophosphamide-vincristineprednisolone-procarbazine regimen (14.9%). Following treatment, 76.1% of patients achieved complete response. The 2-year overall survival (OS) and progression-free survival (PFS) of the entire cohort were 96.5% and 71.1%, respectively. The 2-year OS and PFS for advanced-stage disease were 93.9% and 62.8%, compared to 100% and 82.7% for early-stage disease, respectively (P=0.252 and P=0.052, respectively).

Conclusion

This study provides insight into the clinical presentation and treatment outcomes among patients with cHL in Malaysia. A longer study duration is required to identify OS and PFS benefits and treatment-related complications for different chemotherapeutic regimens.

Keywords: Hodgkin lymphoma, Clinical features, Treatment outcomes, Malaysia

Fig 1.

Figure 1.

Kaplan-Meier survival curve for 2-year OS and PFS for the entire cohort of patients.

Blood Research 2019; 54: 210-217https://doi.org/10.5045/br.2019.54.3.210

Fig 2.

Figure 2.

Kaplan-Meier survival curve for 2-year OS and PFS for patients with early-stage and advanced-stage disease.

Blood Research 2019; 54: 210-217https://doi.org/10.5045/br.2019.54.3.210

Fig 3.

Figure 3.

Kaplan-Meier survival curve for 12-month OS and PFS for patients treated with ABVD and escalated BEACOPP as first-line treatment in newly diagnosed HL.

Blood Research 2019; 54: 210-217https://doi.org/10.5045/br.2019.54.3.210
Baseline characteristics of the patients.

a)B symptoms (fever >38℃; unexplained loss of >10% of body weight over the past six months, and presence of drenching night sweats)..

Abbreviation: IPS, international prognostic score..


Treatment characteristics and response assessment.

Abbreviations: ABVD, doxorubicin, bleomycin, vinblastine, dacarbazine; BEACOPP, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisolone, procarbazine..


Association between 5-year OS and PFS with risk features.

a)Two-sided log-rank test. b)P<0.05 considered statistically significant. c)Missing data=7. d)N=56..


Prognostic factors of PFS in HL using a Cox proportional hazards model.

a)Simple cox proportional hazard regression. b)Forward likelihood ratio multivariate cox proportional hazard regression. c)Missing data=7..

d)P<0.05 considered statistically significant..

Abbreviations: CI, confidence interval; HR, hazard ratio..


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