TREATMENT OUTCOMES IN CLASSICAL HODGKIN LYMPHOMA (HL): 5-YEAR UPDATE REPORT FROM THE BRAZILIAN PROSPECTIVE REGISTRY

Biasoli, I; Castro, N; Villarim, CC; Traina, F; Chiattone, CS; Praxedes, M; Solza, C; Perobelli, L; Baiocchi, O; Gaiolla, R; Boquimpani, C; Buccheri, V; Sola, CB; Silva, ROPE; Ribas, AC; Steffenello, G; Pagnano, K; Soares, A; Medina, SS; Silveira, T; Cecyn, KZ; Goveia, L; Palma, LC; Marques, MO; Souza, C; Spector, N

doi:10.1016/j.htct.2022.09.138

Hematology, Transfusion and Cell Therapy

ISSN: 2531-1379

Hematology, Transfusion and Cell Therapy is a quarterly scientific publication of the Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), Associazione Italo-Brasiliana di Ematologia (AIBE), Eurasian Hematology Oncology Group (EHOG), and Sociedade Brasileira de Oncologia Pediátrica (SOBOPE).

Hematology, Transfusion and Cell Therapy publishes original articles, review articles and case reports covering various areas in the field of hematology and hemotherapy. The journal was previously published, until 2016, as Revista Brasileira de Hematologia e Hemoterapia.

ISSN print: 2531-1379
ISSN online: 2531-1387

Published by Elsevier Editora Ltda, Rio de Janeiro, Brazil.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management.

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Web of Science, LILACS, SciELO Brazil, ESCI (Web of Science), Scopus, and PubMed/PMC

I Biasolia, N Castrob, CC Villarimc, F Trainad, CS Chiattonee, M Praxedesf, C Solzag, L Perobellih, O Baiocchii, R Gaiollaj, C Boquimpanik, V Buccheril, CB Solam, ROPE Silvan, AC Ribaso, G Steffenellop, K Pagnanoq, A Soaresg, SS Medinaq, T Silveirae..., KZ Cecynh, L Goveiaa, LC Palmad, MO Marquesi, C Souzaq, N SpectoraVer más

a Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil

b Hospital de Câncer de Barretos, Barretos, SP, Brazil

c Liga Norte RioGrandense contra o Câncer, Natal, RN, Brazil

d Departamento de Imagem Médica, Hematologia e Oncologia, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil

e Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil

f Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil

g Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil

h Hospital de Transplantes Euryclides de Jesus Zerbini - Hospital Brigadeiro, São Paulo, SP, Brazil

i Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

j Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP, Brazil

k Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil

l Instituto do Câncer do Estado de São Paulo (ICESP)/ Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil

m Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil

n Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

o Centro de Pesquisas Oncológicas (CEPON), Florianópolis, SC, Brazil

p Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil

q Centro de Hematologia e Hemoterapia (Hemocentro), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil

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Introduction

Data about HL in developing countries are scarce. In 2009, a HL prospective registry was launched in Brazil.

Methods

The first analysis was presented with patients (pts) diagnosed from 2009 to 2014. Here we present an updated analysis with pts diagnosed until 2018 and a median follow-up of 5 years.

Results

A total of 1357 pts with HIV negative classical HL were registered from January 2009 to December, 2018. 28 pts were excluded for various reasons, leaving 1329 pts for this analysis. Median age was 30 y/o (13-90). Females comprised 50%. The median time from onset of symptoms to diagnosis was 6 (0-60) months. 862 (65%) had advanced disease. Stage IVB was present in 28%, and a high-risk IPS score in 40%. Comparing pts included from 2009-2014 and 2015-2018, there was an increase in the use of PET for staging (11% vs 36%, p <.0001) and for end-of-treatment (40% vs 79%, p < .0001). ABVD was the first-line treatment in 94% of pts. 34 pts (2.6%) died during the first treatment. Radiotherapy (RT) was used in 72% of pts with limited, 59% with intermediate, and 28% with advanced disease. There was a reduction in the use of RT (44% vs 35%, p = .002) from 2009-2014 to 2015-2018. This reduction was higher in advanced disease (32% vs 24%, p = 0.01). The 5-year progression-free survival (PFS) and 5-year overall survival (OS) were 70% and 86%, respectively. The 5-year PFS in limited, intermediate, and advanced disease were 97%, 82%, and 62% (p < .0001), respectively. The 5-year OS for limited, intermediate and advanced disease were 100%, 94%, and 80% (p < .0001), respectively. The impact of socioeconomic status (SES) on outcomes was analyzed in pts treated with ABVD. The 5-year PFS in higher and lower SES were 75% and 60% (p < .0001). The 5-year OS in higher and lower SES were 90% and 77% (p < 0.0001). The fatality ratio during treatment was 5.0% and 1.1% for lower and higher SES (p < 0.0001). After adjustments for potential confounders, lower SES remained independently associated with poorer survival (HR 2.10 [1.52-2.90] for OS and HR 1.58 [1.26-1.99] for PFS).

Conclusions

This analysis confirmed the predominance of advanced disease and high-risk profile pts. There was an increase in the use of PET and a reduction in RT in recent years. We confirmed that the outcomes are 10-15% lower inBrazil than reported in the literature. SES was an independent factor associated with shorter survival.

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