Objectives: To analyze the clinical characteristics and prognosis of primary extranodal classical Hodgkin lymphoma (PE-cHL). Methods: Clinical features and outcomes of 22 PE-cHL patients who received initial chemotherapy January 2008 to January 2018 were analyzed retrospectively, and compared with 274 primary nodal Hodgkin lymphoma (PN-cHL) patients treated in the same period. Results: With a median follow-up period of 42 months, compared with 274 PN-cHL patients, no significant difference of overall response rate (ORR) or complete remission (CR) rate was found, but the PE-cHL patients showed a higher recurrence rate (36.4% vs. 13.1%, p = .003) and poorer survival [(5-year overall survival (OS) rate: 64.6% vs. 97.7%, p = .001; 5-year progression-free survival (PFS) rate: 42.4% vs. 82.2%, p < .001)]. To minimize the effects of confounding factors, PE-cHL patients were matched with PN-cHL patients at a ratio of 1:1 according to age, gender, histological types and stage. Compared with 22 matched PN-cHL cases, PE-cHL was still associated with poor PFS (5-year PFS: 42.4% vs. 79.9%, p = .004). As to 22 PE-cHL patients, univariate analysis showed elevated serum lactate dehydrogenase (LDH) and elevated platelet (PLT) were associated with poor PFS (p < .05). Discussion: Compared with PN-cHLs, PE-cHLs showed a considerable shorter duration of remission, higher recurrence tendency and poorer survival, indicating that more intensive therapy may be needed. Conclusion:The prognosis of PE-cHL is unfavorable. Elevated LDH and PLT are poor prognostic factors for PE-cHL.

Background In the present study, we have tried to understand how the level of risk and survival probability changes over time for patients with classical Hodgkin’s lymphoma by employing conditional survival and annual hazard as dynamic estimates of prognosis and survival. Methods This retrospective study reviewed the clinical data of patients with newly diagnosed classical Hodgkin’s lymphoma admitted to Peking University Cancer Hospital between January 1, 2008, and December 31, 2017. Conditional survival and annual hazard rate were defined as the survival probability and yearly event rate, respectively, assuming that patients have survived for a defined time. Results A total of 384 patients were included (median age, 32 years; range, 6–77 years), of which 218 (56.8%) patients had early-stage disease. The median follow-up time was 41.3 months. The 5-year conditional overall survival (COS) rates remained favorable and showed an increase from 89% at treatment to 94% at year 5, while the 5-year conditional failure-free survival (CFFS) rate increased from 70% at treatment to 96% at year 5. The annual hazard of failure decreased from over 15% at diagnosis to less than 5% after 3 years. Early-stage patients had constantly lower annual estimates for hazard of death (range, 0–3.0%) and failure (range, 0–14.3%). However, the hazard of failure in advanced-stage patients decreased from 24.2% at diagnosis to below 8% after 3 years, whereas the hazard of death was always at relatively low levels. Patients with a high IPS risk score (≥3) had significantly lower COS and CFFS during the first 4 years. Patients who received the BEACOPP regimen had better 5-year COS and 5-year CFFS than those who received the ABVD regimen. Conclusion The survival probability increased and hazard of failure decreased over time.

Objective: To investigate the efficacies of different second-line therapies and outcomes of relapsed or refractory (R/R) classical Hodgkin lymphoma (cHL). Methods: From 2008 to 2017, 108 R/R cHL patients received second line therapies at Lymphoma Department of Peking University Cancer Hospital. We retrospectively reviewed the clinical data and outcomes. Results: Among 108 patients, 74 (68.5%) were male. At the time of cHL diagnosis, the median age was 28 years; 48 (44.4%) patients were stage Ⅰ-Ⅱ and 60 (55.6%) patients were stage Ⅲ-Ⅳ. 79 (73.1%) patients were primary refractory while 29 (26.9%) patients relapsed after initial therapy. The overall response rate (ORR) of 108 cases was 66.7% of second-line salvage therapy. Only 29 (26.9%) patients achieved complete remission (CR). 20 patients achieved CR or PR at two cycles of salvage therapy but developed progressive disease after four cycles. 82 (75.9%) patients received DICE regimen (dexamethasone, ifosfamide, cisplatin and etoposide) or ICE regimen (ifosfamide, carboplatin and etoposide) as salvage therapy, 11 (10.2%) patients received ABVD regimen (adriamycin, bleomycin, vincristine, dacarbazine) or BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), 12 (11.1%) patients received GemOx regimen (gemcitabine and oxaliplatin) or GDP regimen (gemcitabine, cisplatin and dexamethasone), 3 (2.8%) patients received other chemotherapy. The ORR of DICE/ICE, ABVD/BEACOPP and GemOx/GDP group were 72%, 81.8% and 16.7% (p=0.001). With a median follow-up time of 34 months, the 3-year overall survival (OS) rate and 3-year progression-free survival (PFS) rate of all patients were expected to be 83% and 58.5%. The 3-year OS rate of DICE/ICE, ABVD/BEACOPP and GemOx/GDP group were 83.2%, 81.8% and 71.3% (p=0.572). The 3-year PFS rate of DICE/ICE, ABVD/BEACOPP and GemOx/GDP group were 63.7%, 63.6% and 40% (p=0.157). 60 (55.6%) patients received autologous hematopoietic stem cell transplantation (AHSCT) and 3-year OS was 90.4%, which showed a significant survival improvement as compared with patients without AHSCT (3-year OS 72.6%, p=0.013). Conclusion: In this study, DICE/ICE regimen as second-line salvage therapy for R/R cHL was more effective than GemOx/GDP regimen. AHSCT could significantly improve survival of R/R cHL. Disclosures Song: Peking University Cancer Hospital (Beijing Cancer Hospital): Employment. Zhu:Beijing Cancer Hospital: Employment.

Background Patients with lymphoma and hepatitis B virus infection need to be treated with both chemotherapy and nucleotide analogues (NAs) therapy. However, the dynamic change of HBV DNA with the increase of chemotherapy cycles is lacking. It is unknown that whether HBV replication markers: quantitative hepatitis B core antibody (qAnti-HBc), HBV RNA, and hepatitis B virus core-related antigen (HBcrAg) are also sensitive to predict HBV reactivation (HBVr). Methods From 29th June 2010 to 6th December 2021, clinical data and serial serum samples were collected from patients with diffuse large B lymphoma and HBV infection. Serum HBV DNA load (real time fluorescent quantitative PCR), qAnti-HBc (developed chemiluminescent particle immunoassay), HBV RNA (simultaneous amplification testing method based on real-time fluorescence detection), and HBcrAg (Lumipulse G HBcrAg assay) were tested and actors related to HBV DNA reactivation were analyzed. Results Under the NAs, load of HBV DNA in 69 HBsAg + lymphoma patients declined from 3.15 (2.13–4.73) lg IU/ml at baseline to 1.00 (1.00-1.75) lg IU/ml at the end of chemotherapy, and further declined to 1.00 (1.00-1.04) lg IU/ml at the end of 24-month follow-up. Serum qAnti-HBc level decreased gradually during chemotherapy in HBsAg + lymphoma patients (F = 7.090, p = 0.009). Serum HBV RNA and HBcrAg levels stayed stabled. Multivariate analysis revealed that a higher level of qAnti-HBc (1.97 ± 1.20 vs. 1.12 ± 0.84 lg IU/ml, OR = 8.367, [95% CI:1.439–48.645], p = 0.018) and a higher level of HBV RNA (1.00 ± 1.13 vs. 0.37 ± 0.80 lg copies/ml, OR = 3.654, [95% CI:1.208–11.048], p = 0.022) were related to HBVr in HBsAg-/anti-HBc + lymphoma patients. Conclusions The HBV DNA load declined by NAs under chemotherapy in lymphoma patients. In HBsAg-/anti-HBc + lymphoma patients, higher level of baseline serum qAnti-HBc and HBV RNA predict the HBVr during chemotherapy.

Patients with lymphoma who are also infected with Hepatitis B virus (HBV) have a poor prognosis. This could be partly explained by the delay or premature termination of anti-tumor treatment because of HBV reactivation. However, there is limited data on the survival outcome of patients HBV-related lymphoma in the era of prophylactic antivirals. Data for 128 patients with HBV surface antigen-positive diffuse large B-cell lymphoma was collected. The median age was 54 years and the ratio of men to women was 1.2:1. All patients received immune-chemotherapy and prophylactic antiviral therapy. The median number of cycles of immune-chemotherapy was six. The overall response rate was 82%, with a complete remission rate of 75%. With a median follow-up of 58.4 months, the 5-year progression-free survival and overall survival rates were 75.7% and 74.7%, respectively. Nine patients experienced HBV reactivation but none experienced HBV-associated hepatitis. Patients with low and high HBV DNA loads had comparable survival outcomes. In conclusion, HBV infection had no negative effect on the prognosis of DLBCL in the era of prophylactic antiviral therapy.