Hodgkin Lymphoma - Mitigating Toxicity While Preserving Cure - Eight Year Data from MIOT International, Chennai, India
Authors: Kumar Kishore , Subash Chezhian , Prabhu Durai , R Manikandan , Dr Senthooran 
Published: December 2023

Background

One of the most treatable cancers, Hodgkin's lymphoma (HL), has a 5-year survival rate of approximately 85%.We still see relapse and refractoriness in a tiny percentage of patients despite the fact that our disease is largely curable, and we also have additional issues including secondary neoplasia and long-term consequences on the heart. Our Hodgkin lymphoma statistics from 2011 to 2019 have been given in this paper.

Methodology

Between 2011 and 2019, data on patients with newly diagnosed classical HL (CHL) who received treatment were gathered. Analysis was done on the presenting characteristics, IPS risk classification, treatment procedures, treatment response, and 3-year outcome data.

Results

At presentation, there were 97 patients with newly diagnosed CHL, with a median age of 24 years (range, 11-72). The ratio of men to women was 1.62:1. Mixed cellularity, lymphocyte-rich, and lymphocyte-depleted CHL (LD, CHL) were histological subtypes that were present in 80.40%, 12.40%, and 7.20% of cases, respectively. At presentation, 52% of patients had advanced illness, and 80% had B symptoms. The Hodgkin IPI score was high in 58% of individuals with advanced stages. ABVD was given as the first line of therapy to 92% of patients. According to interim PET-CT scan findings, around 7 advanced stage Hodgkin patients were started with EscBEACOPP and then switched to ABVD prior to 2017. The front line treatment's overall response rate was 94.8%. Complete response rates for early-stage favourable and unfavourable risk groups were 94% and 86%, respectively, whereas they were 81% and 67% for advanced-stage low- and high-risk groups. The median duration of event free survival was 36 months. The 3-year EFS showed a significant difference between the early- and advanced-stage diseases, 93% and 81%, respectively (p 0.04). Relapse was found in eight patients, all of whom had BEAM Autograft post platinum based salvage treatment. Following interim PET negativity, we discontinued Bleomycin according to RATHL protocol. Three of our patients had bleomycin lung injury. Three patients had post-autograft recurrence, one of whom passed away due to a subsequent non-Hodgkin lymphoma. With the Brentuximab Bendamustine regimen, two patients were successfully salvaged and they had Haplo-identical transplant as third line salvage.

Conclusions

In early and late stage Hodgkin lymphoma, the three year EFS of 93% and 81% is equivalent to most western literature. In light of our little experience with Indian patients, the effect of Brentuximab is overwhelmingly favorable. At our facility, post-Autograft Brentuximab maintenance is being tested. There is no information on how Nivolumab will be useful in our context. Although there is little evidence to draw a conclusion that is statistically significant, frontline ABVD protocol treatment across risk categories and discontinuing Bleomycin after interim PET negative are helpful in our patients to enhance prognosis and decrease toxicity.

Reference: Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin's Lymphoma N Engl J Med 2016; 374:2419-2429 DOI: 10.1056/NEJMoa1510093Mohty, R., Dulery, R., Bazarbachi, A.H. et al. Latest advances in the management of classical Hodgkin lymphoma: the era of novel therapies. Blood Cancer J. 11, 126 (2021). https://doi.org/10.1038/s41408-021-00518-z