Progress in Hodgkin lymphoma: a population-based study on patients diagnosed in Sweden from 1973-2009

Abstract

In recent decades, attention has focused on reducing long-term, treatment-related morbidity and mortality in Hodgkin lymphoma (HL). In the present study, we looked for trends in relative survival for all patients diagnosed with HL in Sweden from 1973-2009 (N ‫؍‬ 6949; 3985 men and 2964 women; median age, 45 years) and followed up for death until the end of 2010. Patients were categorized into 6 age groups and 5 calendar periods (1973-1979, 1980-1986, 1987-1994, 1994-2000, and 2001-2009 IntroductionOver the past 40 years, major advances have been made in the management of patients with Hodgkin lymphoma (HL). These include the introduction of more accurate radiotherapy, effective multiagent chemotherapy, immunotherapy, improved staging procedures, and important developments in supportive measures for myelosuppression and infectious and other complications. 1 Therefore, HL has gone from being an invariably fatal disorder to one of the few malignancies that are now highly curable. This is particularly true for patients with early-stage disease, but today disease control rates also exceed 70% in patients presenting with high-risk features. 2 This therapeutic success has unfortunately been darkened by elevated risks of secondary primary cancers, cardiovascular disease (CVD), cerebrovascular disease, and infections in longterm HL survivors. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] CVD has been reported to be the most important cause of excess mortality after HL and second malignancies. [10][11][13][14] During the last 2-3 decades, treatment strategies have been and are being adapted based on increased knowledge of treatment-related morbidity and mortality. Awaiting novel and less toxic targeted therapies of HL, the largest potential for improving survival and healthrelated quality of life in long-term survivors 17 is by reducing the excess morbidity and mortality from causes other than HL. To evaluate progress in long-term outcome, we studied patient survival among all 6949 HL patients diagnosed in Sweden between 1973 and 2009 and followed up for death to the end of 2010. Our aim was to assess trends in patient survival and long-term excess mortality in the entire population during this 37-year period starting when curative treatment principles were well-established. Methods Central registers and patientsInformation regarding patients diagnosed with a malignant disorder in Sweden is reported to a population-based nationwide Swedish Cancer Register that was established in 1958. The register contains information on diagnosis, sex, date of birth, date of diagnosis, and the hospital where the diagnosis was made, 18-19 but does not contain detailed clinical information such as symptoms, routine laboratory tests, treatment, or comorbidities.In Sweden, every physician and pathologist/cytologist is obliged by law to report each occurrence of cancer to the registry. All deaths are recorded in the nationwide causes of death register. Each person in Sweden is given a unique national registration number used to index a...

Autologous stem cell transplantation for patients aged 60 years or older with refractory or relapsed classical Hodgkin’s lymphoma: a retrospective analysis from the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC)

“…1 Their survival rates are inferior to those of younger patients (5-year survival rates of 50 versus 80%, respectively) for several reasons, including disease features, lower delivery of standard chemotherapy and excessive toxicity. [2][3][4][5][6][7][8][9][10][11][12][13][14] No standard of care is available for first 14 or additional lines of chemotherapy for this age group. ASCT is a usual treatment in R/R cHL young patients.…”

“…1 Their survival is inferior compared with younger patients despite similar treatments. 2 These disappointing results are attributed to several factors, such as a greater number of co-morbidities, poor performance status, different histological and biological features, lower chemotherapy doses and more toxicity with an increased related mortality rate for the oldest patients. As mentioned, elderly patients experience more refractory or relapsed (R/R) disease, and the German Hodgkin Study Group has reported a series of 105 R/R cHL patients treated in its trials and concluded that 'the poor outcome of high-risk patients based on time to relapse, clinical stage and anemia, cannot be overcome by any strategies including high-dose chemotherapy'.…”

How I treat advanced classical Hodgkin lymphoma

“…70 The prolonged use of bleomycin in ABVD in this group is attended by significant rates of severe pulmonary impairment (43% in one North American intergroup study 71 ), and more intensive approaches such as BEACOPP result in high treatment-related mortality (21% in a GHSG trial 72 ), a problem only partly attenuated by the omission of etoposide in the BEACOPP regimen, in which there were still 12% treatment-related deaths. 73 Attempts have been made to develop regimens specifically for use in older patients, such as vinblastine, cyclophosphamide, prednisolone, procarbazine, etoposide, mitoxantrone, and bleomycin (VEPEM-B), 74 which has been tested in a prospective United Kingdom study of 31 early-stage and 72 advanced-stage patients with a median age of 73 years.…”

Chłoniak Hodgkina u osób w wieku podeszłym

“…Dane szwedzkie dotyczące 6949 chorych z HL wskazują na poprawę rokowania w 3 ostatnich dekadach. Było to szczególnie widoczne w grupie wiekowej 36-80 lat, jednak nie dotyczyło to chorych powyżej 80. roku życia [7]. Podobną poprawę w 10-letnim względnym przeży-ciu zaobserwowano w USA u chorych w wieku 45-59 i starszych [8].…”