Classical Hodgkin lymphoma: A Surveillance, Epidemiology, and End Results (SEER) Database analysis comparing racial and ethnic disparities with emphasis on Hispanics.
Authors: Toro-Vélez Esteban , Velez-Mejia Carolina , Rosas Daniel , Kaur Supreet , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique 
Published: June 2023

e19514

Background: Classical Hodgkin Lymphoma (cHL) and it’s 4 subtypes, account for 95% of cases of Hodgkin Lymphoma in Western countries (J Natl Compr Canc Netw PMID 35390768). Race is a known survival predictor for this disease and studies have shown that outcomes vary between Non-Hispanic (NH) and Hispanic (HI) patients (Adv Hematol PMID 21197477 Ann Oncol PMID 22241896). This analysis attempts to clarify how sociodemographic characteristics influence survival of HI diagnosed with cHL in the United States (US). Methods: Retrospective data analysis on cHL patients in the US reported to the Surveillance, Epidemiology, and End Results (SEER) 18 database from 2000-2018. Demographics, disease characteristics, and survival patterns were analyzed for each ethnic group. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS). Multivariate analysis and propensity score matching was performed, adjusting for age, stage, and B-symptoms. Results: 40776 cHL patients were included, 6621 HI. Males predominated in both HI and NH. HI compared to NH, were diagnosed at a younger median age, 34 years(y) vs 39y, respectively [p < 0.001]. Majority of patients belonged to the age bracket of less than 40y; favoring a younger age distribution in both ethnicities. Most patients were white, and NH had greater heterogeneity [p < 0.001]. Stage II at diagnosis prevailed in HI (29.8%) and NH (33.7%), followed by unknown for both [p < 0.001]. Preponderance of cases were nodal disease, ≈98% for HI and NH [p = 0.014]. Presence of B-symptoms was 23% for HI vs 19% for NH [p < 0.001]; however, B-symptoms were mostly unknown for both. Only 27% of HI and 31% of NH received radiation. Survival probability at 2, 5 and 10y for HI (0.856, 0.804, and 0.737) was similar compared to NH (0.864, 0.804 and 0.733), respectively. Median survival time wasn’t reached for HI and NH, with no statistically significant difference in OS among ethnicities [p = 0.64]. On multivariate analysis, patients older than 80y and between 60-80y, had worse OS than those less than 60y, with hazard ratio (HR) 17 [95% CI: 15.6–18.7] and 6.31 [95% CI: 5.9–6.7], respectively. Stage III/IV had inferior OS vs early stages, with HR 1.5 [95% CI: 1.38–1.66] and 2.3 [95% CI: 2.1–2.5], respectively. Conclusions: No statistically significant difference in OS was noted between HI and NH diagnosed with cHL, despite HI presenting with more B-symptoms, younger age, and less likely diagnosed at early stages. On multivariate analysis, HI older than 60y and with advance stage do have inferior OS. This suggests that unique disease characteristics, environmental and biological factors may have some influence that drive survival outcomes, especially in the elderly. Although racial disparities and different disease characteristic exist, cHL remains a malignancy with favorable outcomes for both HI and NH.