ABSTRACT
Aim of the work: the aim of the study was to analyze the correlation between several clinico-pathological prognostic factors in classical type Hodgkin lymphoma and its effect on response to treatment and survival rates [PFS and OS]. The primary endpoint is response rate and secondary endpoints are survival rates
Patients and methods: this study was performed on 76 patients diagnosed as classical Hodgkin lymphoma that were recruited retrospectively from January 2010 to December 2015 in Nasser Institute Oncology Centre and Ain Shams Clinical Oncology Department. Patients' risk factors in the whole group were analyzed using univariate and multivariate regression analysis. They included age, sex, pathological type, B symptoms, performance status, stage, extranoadal disease, bulky disease, inflammatory markers and their correlation on complete response rate [CR], progression free survival [PFS] and overall survival [OS]
Results: nodular sclerosing type was the most common in 44.7% of patients followed by mixed cellularity in 21.1% of patients followed by lymphocyte predominant in14.4% of patients, while unclassified classical constituted 19.7%. Early disease [Stage I, II] constituted 68.4% of patients and late disease [Stage III, IV] was found in 31.6% of patients. Bulky and extranodal diseases were found in 28.9% and 21.05% of patients respectively. All of patients received first line ABVD with 59.2% of patients received consolidative or palliative radiotherapy. CR rate was 65.8% being 71.2% in the early versus 52% in the advanced stage [p=0.07] with a relapse rate of 7.8%. The CR was negatively correlated with pathological type being worse in nodular sclerosing subtype than mixed cellularity [p=0.02], poor performance status [p=0.016], bulky disease [p=0.004], extranodal disease [p=0.0381], elevated LDH [p=0.045] and leucocytosis and lymphopenia [p=0.005]. Median PFS was 17.5 months with a range of 1 to 75 months. 5 year PFS was negatively correlated with advanced stage than early stage [p=0.019], Bulky disease than non bulky [p=0.003], extranodal disease than nodal [p=0.014], leucocytosis and lymphopenia [p= 0.002]. Median overall survival is 28 months with a range of 6-81 months with 5 years survival rate of 82.9% and mortality rate of 17.1%. 5 year overall survival was negatively associated with bulky rather than non bulky [p=0.05] and extranodal more than nodal [p=0.007]
Conclusion: this study concluded that both overall and progression free survival and response rates were negatively affected by stage, bulky and extranodal disease mainly. Pathological subtype and elevated ESR and LDH negatively affected CR rate. Leucocytosis and lymphopenia had a significant negative effect on response rate and progression free survival. This allowed the use of risk adapted treatment at several stages tailoring treatment to each patient separately