Outcome with combined modality treatment (CMT) in patients with Hodgkin's lymphoma

Aim/Background

To examine the impact of CMT in patients with early as well as advanced stage HL.

Methods

From January 2001 to June 2011, 125 patients with stage I to IV HL were analyzed (Table 1). Median age of the patients was 25 year (range 12-68 years). Chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine(ABVD), ABVD-like and COPP regimen was given to 100(87%), 6(5%) and 9(8%) patients respectively. Radiotherapy was given to 61(49%) patients; IFRT to 55(90%) and EFRT to 6(10%) patients respectively. Median radiation dose was 30Gy (18-40Gy). CMT was used in 51(41%) patients.

Results

All patients with early stage (n = 25, 20%) had complete response (CR = 100%) with CMT. At a median follow up of 58 months (range 6-212 months) relapse was seen in 2 patients (1 local and 1distant). In advanced stage patients (n = 26, 21%), 25 patients had CR and 1 had stable disease. Relapse occurred in 1 patient (distant). In early stage patients treated with chemotherapy only (n = 30, 24%), 9 patients had relapse (4 local, 5 distant) while in those with radiotherapy only (n = 10, 8%), 4 developed distant relapse. In advanced stage patients treated with chemotherapy only (n = 34, 27%), 8 relapsed (5 local & distant, 3 distant). Patients with relapse were salvaged with chemotherapy (n = 15), CMT(n = 6), or radiotherapy(n = 3). Two patients have died. Five year event free survival (EFS) in patients with early favourable, early unfavourable and advanced stage was 91%, 73%, 82% respectively (p = 0.026). EFS was significantly better with CMT than chemotherapy or radiation alone. Five year overall survival (OS) was 93%, 92% and 84% respectively (p = 0.139). Second malignancy occurred in 3 (2.4%) patients; carcinoma of tongue, pseudomyxoma peritonei and NHL each respectively. None of these had received prior radiotherapy.

Conclusions

CMT improved EFS in patients with HL. OS was similar in all patients irrespective of treatment combinations. The incidence of second malignancy was 2.4%.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.