Treatment of Early Stage Classic Hodgkin's Lymphoma Outcome: Kuwait Experience
Authors: Alshemmari Salem H , Elhagracy Rehab S , Elbasmy Amany 
Published: October 2019

Abstract
Abstract 4948
Treatment of early stage classical Hodgkin's lymphoma (CHL) I&II had been changed over the last decades. This study evaluated the treatment outcome for early stages CHL patients who were treated by 6 versus 4 ABVD cycles with or without radiotherapy (RT) to the residual or bulky sites. The study retrospectively analyzed cases with early stage CHL patients diagnosed & treated in Kuwait Cancer Control Center from 2001–2010. Staging confirmed by computed tomography, nuclear studies:Gallium or recently Positron emission tomography.
Data analyzed by SPSS version 15 & described using mean and standard deviation (SD) or frequencies according to data type. Chi square test was used for comparison of qualitative variables; survival analysis was performed by Kaplan-Meir analysis and regression model performed with Cox regression model. Significance considered if p ≤0.05 & highly significant if ≤0.01.
The study included 105 patients that were further subdivided into Group A included 34 patients treated with 4 cycles and group B included 71 patients were treated by 6 cycles. Table(1)demonstrated cases characteristics. There were 61 males and 44 female with male:female ratio 1.3:1. Nodular sclerosis attributed to 66.6%, mixed cellularity 26.6%, lymphocyte rich 5.7% and lymphocyte depleted 0.9% of cases.Table (1):Characteristic Differences between group A & B.ParametersGroup A n=34Group B n=71pAge mean±SD37.41±16.15928.44±11.4740.005Sex female/males n (%)13(38.2)/21(61.7)31(43.6)/40(56.3)0.675B symptoms positive n (%)6 (17.6)32 (45)0.009Stage I n (%) II n (%)13 (38.2) 21 (61.7)7 (9.8) 64 (90.1)0.001IA 18 (17.1%)12 (35.2)6 (8.4)IIA 49 (46.6%)16 (47)33 (46.4)IB 2 (1.9%)1 (2.9)1 (1.4)IIB 36 (24%)5 (14.7)31 (43.6)Presence of Bulky disease n (%)5 (14.7)21 (29.5)0.146Presence of Extranodal site n (%)4 (11.7)4 (5.6)0.329Groups of lymph node ≥412(35.3)41(57.7%)ESR ≥ 50mm/hr n (%)36(34.28)6(17.6)30(42.2)mean±SDmean±SDTLC X109/L8.09± 3.10810.42±4.4580.007HB g/L12.36±2.1211.67±1.900.09Plat X109/L349.21±88.429400.17±151.4880.033Lymphocytes X109/L1.65±0.6711.74±0.7900.491ESR mm/hr28.21±22.15347.69±33.4500.001Max mass size by CM4.94±2.7955.39±3.0260.464Albumin g/L39.59±4.65936.62±6.0320.013LDH IU/L178.41±46.639183.90±85.3420.727
Age was significantly lower in group B (p=0.005), that may attributed to the heterogeneity of population. Group B significantly had more B symptoms, higher platelets, ESR, TLC & lower albumin level.
RT was delivered to total 60(57.1%) cases; 28(82.3%) in group A and 32(45%) in group B. Thirty six of cases received 30 Gy and 20 received 36 Gy. The commonly radiated sites were cervical nodes 53.3% followed by the mediastinum in 41.6%.
Complete remission (CR) achieved in 84 (80%) of cases, while 6 (5.7%) showed residual disease (RD) & progression (PD) on therapy and 15 (14.3%) of cases developed relapse on follow up. In group A; 82.2% of patients achieved CR compared to 76.1%. Relapse incidence was 16.9%(12) in group B compared to 8.8%(3) in group A.
Thirteen patients were treated by high dose chemotherapy followed by ASCT; 7 with relapse (2 from A & 5 from B) & 6 cases with SD/PD (1 from A & 5 from B). Among relapsed cases 6 died (4 from group B & 2 from group A). Four patients with RD/PD died (3 from group B, 1 from group A).
No significant difference was found between the two groups regarding CR, PD or relapse incidence (p=0.40).
Kaplan-Mayer survival study showed 5-years survival rate was 86%; without significant difference between group A 85 % or group B 87% (p=0.51).
Those without B symptoms had significantly better 5-years survival rate 92% compared to those with B symptoms 73 % (p=0.02).
Although those patients with bulky disease showed inferior 5-years survival rate 77 % compared to those without bulky disease 89%,the difference was not statistically significant (p=0.1).
Lower ESR < 50 mm/hr had better 5-years survival 89 % compared to high ESR ≥ 50 mm/hr 82 % with no significant difference (p=0.51).
Events free survival time was difficult to determine attributed to minor events among patients. There were no cardiopulmonary toxicities or secondary malignancy detected in patients on 5-years follows up.
This suggests that treatment of early stage CHL by combined chemo-radiotherapy associated with better survival. ABVD 4 cycles is adequate as 6 cycles in early stages.

Disclosures:
No relevant conflicts of interest to declare.