Relapse Risk and Loss of Lifetime After Modern Combined Modality Treatment of Young Patients With Hodgkin Lymphoma: A Nordic Lymphoma Epidemiology Group Study

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Abstract

PURPOSE: Estimates of short- and long-term survival for young patients with classic Hodgkin lymphoma (cHL) are of considerable interest. We investigated cHL prognosis in the era of contemporary treatment at different milestones during the follow-up. PATIENTS AND METHODS: On the basis of a Nordic cohort of 2,582 patients diagnosed at ages 18 to 49 years between 2000 and 2013, 5-year relapse risks and 5-year restricted losses in expectation of lifetime were estimated for all patients and for patients who achieved event-free survival (EFS) for 12 (EFS12), 24 (EFS24), 36 (EFS36) or 60 (EFS60) months. The median follow-up time was 9 years (range, 2.9 to 16.8 years). RESULTS: The 5-year overall survival was 95% (95% CI, 94% to 96%). The 5-year risk of relapse was 13.4% (95% CI, 12.1% to 14.8%) overall but decreased to 4.2% (95% CI, 3.8% to 4.6%) given that patients reached EFS24. Relapse risk for patients treated with six to eight courses of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) was comparable to that of patients treated with six to eight courses of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) despite more adverse risk criteria among patients treated with BEACOPP. Both from diagnosis and if EFS24 was reached, the losses in expectation of lifetime during the following 5 years were small (from diagnosis, 45 days [95% CI, 35 to 54 days] and for patients who reached EFS24, 13 days [95% CI, 7 to 20 days]). In stage-stratified analyses of 5-year restricted loss in expectation of lifetime, patients with stages I to IIA disease had no noteworthy excess risk of death after they reached EFS24, whereas risk remained measurable for patients with stages IIB to IV cHL. CONCLUSION: Real-world data on young patients with cHL from the Nordic countries show excellent outcomes. The outlook is particularly favorable for patients who reach EFS24, which supports limited relapse-oriented clinical follow-up.

Detaljer

Författare
  • Jorne Lionel Biccler
  • Ingrid Glimelius
  • Sandra Eloranta
  • Knut B. Smeland
  • Peter de Nully Brown
  • Lasse Hjort Jakobsen
  • Henrik Frederiksen
  • Mats Jerkeman
  • Alexander Fosså
  • Therese M.L. Andersson
  • Harald Holte
  • Martin Bøgsted
  • Tarec Christoffer El-Galaly
  • Karin E. Smedby
Enheter & grupper
Externa organisationer
  • Aalborg University
  • Karolinska Institute
  • Uppsala universitet, Historiska institutionen
  • Oslo university hospital
  • Copenhagen University Hospital
  • Aalborg University Hospital
  • Odense University Hospital
  • Karolinska University Hospital
  • Uppsala University Hospital
  • University of Oslo
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Cancer och onkologi
Originalspråkengelska
Sidor (från-till)703-713
Antal sidor11
TidskriftJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volym37
Utgivningsnummer9
StatusPublished - 2019 mar 20
PublikationskategoriForskning
Peer review utfördJa