Two distinct prognostic groups in advanced-stage Hodgkin lymphoma revealed by the presence and site of bulky disease
Open Access
- 12 May 2020
- journal article
- research article
- Published by American Society of Hematology in Blood Advances
- Vol. 4 (9), 2064-2072
- https://doi.org/10.1182/bloodadvances.2019001265
Abstract
Controversy exists regarding the definition and prognostic significance of bulk in advanced-stage (stage III/IV) Hodgkin lymphoma (ASHL), and bulk location (mediastinum vs other sites) further complicated the setting. This retrospective, multi-institutional study comprised 814 ASHL patients between 2000 and 2010 and aimed to evaluate the significance of bulk in ASHL. End points of interest included progression-free survival (PFS) and overall survival (OS). Covariates included maximum diameter and the site of bulky disease. SmoothHR and Kaplan-Meier analyses were used to assess for an association of PFS and OS with covariates. In the exploratory cohort (n = 683), maximum diameter had no association with PFS and a complex, U-shaped association with all-cause mortality on smoothHR analysis. Using 5 cm as a cutoff for bulk, Kaplan-Meier analyses confirmed the smoothHR results. The site of bulk was incorporated to divide patients into 2 groups. The mediastinal bulk (MB) type had more favorable characteristics than the nonbulky/non-MB (NB/NMB) type on age, histology, and bone marrow involvement (P < .001). The MB type was associated with better OS than the NB/NMB-type on univariable analysis (5-year OS, 92% vs 86%; HR, 0.53; 95% confidence interval, 0.34-0.84; P = .007). These findings persisted in the subgroup treated with chemotherapy alone and were confirmed in an independent validation cohort (n = 131). Our findings indicate that mediastinal bulk was associated with more favorable disease characteristics and improved OS in ASHL, and may be a surrogate of a more favorable biology.This publication has 35 references indexed in Scilit:
- Flexible hazard ratio curves for continuous predictors in multi-state modelsStatistical Modelling, 2010
- Randomized Comparison of the Stanford V Regimen and ABVD in the Treatment of Advanced Hodgkin's Lymphoma: United Kingdom National Cancer Research Institute Lymphoma Group Study ISRCTN 64141244Journal of Clinical Oncology, 2009
- Escalated-Dose BEACOPP in the Treatment of Patients With Advanced-Stage Hodgkin's Lymphoma: 10 Years of Follow-Up of the GHSG HD9 StudyJournal of Clinical Oncology, 2009
- Hodgkin Lymphoma: An Update on its Biology with New Insights into ClassificationClinical Lymphoma Myeloma and Leukemia, 2009
- ABVD Compared With BEACOPP Compared With CEC for the Initial Treatment of Patients With Advanced Hodgkin's Lymphoma: Results From the HD2000 Gruppo Italiano per lo Studio dei Linfomi TrialJournal of Clinical Oncology, 2009
- Classification of lymphoid neoplasms: the microscope as a tool for disease discoveryBlood, 2008
- Revised Response Criteria for Malignant LymphomaJournal of Clinical Oncology, 2007
- Primary Mediastinal Large B-Cell LymphomaThe Oncologist, 2006
- Advanced hodgkin disease with large mediastinal involvement can be treated with eight cycles of chemotherapy alone after a major response to six cycles of chemotherapyCancer, 2001
- A Prognostic Score for Advanced Hodgkin's DiseaseThe New England Journal of Medicine, 1998