Epidemiology Projection Trends for Hodgkin Lymphoma Patients in the U.S. and Europe
Authors: Mehta Jyotsna , Abbe Adeline , Trask Peter C , Neumann Frank , Hamed Alaa 
Published: October 2019

Abstract
Abstract 4782

Background:
Hodgkin lymphoma represents 11.7% of all types of lymphoma diagnosed in 2011. (Leukemia and Lymphoma Society) In 2012, an estimated 9,060 of new HL cases and 1,190 deaths will occur in North America and mostly in either young adults between 15 and 30 years of age, or after the age of 45. (American Cancer Society) The five-year relative survival rate for all patients with HL is 86.3% from 2001 to 2007 and 92.8% for patients less than 45 years at diagnosis. (SEER Review) Initial treatment of HL depends on the stage of the disease at diagnosis. Chemotherapy with or without radiation therapy is the most common treatment approach for HL patients. Stem cell transplantation and chemotherapy are the treatment options for patients with relapse disease. There is lack of published data on the distribution of patients across lines of therapy as well as percentage of relapsed and refractory patients. Understanding the distribution of patients across lines of therapy is critical to identify the unmet need and to help tailor future therapies.

Methods:
Epidemiological data was obtained for US and EU using the 'epic oncology' 2012 database (Epiphany Partners Inc.). The database includes line of therapy estimations using an advanced patient flow model combining survival by subset and course of treatment, response rates and outcomes, and treatment data from US and EU cancer registries coupled with primary research with a representative sample of physicians and secondary therapeutic reviews. We analyzed projection estimates up to 2020 across US and EU5 countries by line of therapy with specific attention to relapsed/refractory patients. These projection estimates are based on the current treatment options and does not account for introduction of future therapies. Refractory patients are defined as those who do not respond (do not go into remission) following therapy. Relapsed Patients are defined as those who have responded to therapy (enter remission) but re-enter the treatment population at a later stage due to progression of their cancer, recurrence of diagnostic markers, or symptomatology.

Results:
Projection estimates from 2010 to 2020 by line of therapy varied by country. Among EU countries, the highest number of treated HL patients was in France, followed by Italy and Spain. By 2020, the percentage of patients that are either relapsed or refractory to first, second and third line of therapy will increase by about 25% in US and by about 15% in EU. Regional variation observed across Europe are as follows: an increase by 38% in Spain, 25% in France, 12% in UK and 6% in Italy, while Germany will show a decline of 2%, this is due to a continuous decline in incidence rates since the early 1990s.
Drug treated Hodgkin lymphoma population by line of therapy*:

Conclusions:
Due to the highly chemosensitive nature of the malignancy, only about 25% of Hodgkin lymphoma patients progress to a second line therapy and 30% of those move into third line. Smaller sample sizes, variation in growth rate among US and EU countries, and a bimodal incidence curve could cause differences in projection trends. The creation of a Hodgkin's disease based registry can help in validating emerging trends in therapy through providing up to date global projection estimates across line of therapy. Our results provide a global understanding of the HL patient population distribution across lines of therapy and are critical to identify the unmet need and guide future therapies in HL patients.

Disclosures:
Mehta: Sanofi: Employment. Abbe:Sanofi: Employment, Equity Ownership. Trask:Sanofi: Employment. Neumann:Sanofi-aventis: Employment. Hamed:Sanofi: Employment.