Early‐stage Hodgkin lymphoma in the modern era: simulation modelling to delineate long‐term patient outcomes

Abstract

SummaryWe developed a novel simulation model integrating multiple data sets to project long‐term outcomes with contemporary therapy for early‐stage Hodgkin lymphoma (ESHL), namely combined modality therapy (CMT) versus chemotherapy alone (CA) via 18F‐fluorodeoxyglucose positron emission tomography response‐adaption. The model incorporated 3‐year progression‐free survival (PFS), probability of cure with/without relapse, frequency of severe late effects (LEs), and 35‐year probability of LEs. Furthermore, we generated estimates for quality‐adjusted life years (QALYs) and unadjusted survival (life years, LY) and used model projections to compare outcomes for CMT versus CA for two index patients. Patient 1: a 25‐year‐old male with favourable ESHL (stage IA); Patient 2: a 25‐year‐old female with unfavourable ESHL (stage IIB). Sensitivity analyses assessed the impact of alternative assumptions for LE probabilities. For Patient 1, CMT was superior to CA (CMT incremental gain = 0·11 QALYs, 0·21 LYs). For Patient 2, CA was superior to CMT (CA incremental gain = 0·37 QALYs, 0·92 LYs). For Patient 1, the advantage of CMT changed minimally when the proportion of severe LEs was reduced from 20% to 5% (0·15 QALYs, 0·43 LYs), whereas increasing the severity proportion for Patient 2's LEs from 20% to 80% enhanced the advantage of CA (1·1 QALYs, 6·5 LYs). Collectively, this detailed simulation model quantified the long‐term impact that varied host factors and alternative contemporary treatments have in ESHL.

No excess long‐term mortality in stage I‐IIA Hodgkin lymphoma patients treated with ABVD and limited field radiotherapy

“…Non‐fatal toxicity, such as chronic fatigue, endocrine dysfunction and infertility, are important aspects in cancer survivorship. A model for assessing the impact of chosen treatment on estimated quality‐adjusted life years for patients presently treated has been published (Parsons et al , ). To accurately predict the evolution of healthcare and its capacity to deal with late toxicity 20–60 years into the future is extremely hard.…”

Personalised Approaches in Treating Early-Stage Hodgkin Lymphoma

“…Can modelling help with this complex clinical risk decision making in evaluating risks and benefits with these different treatment options and whether to consolidate with RT. Early attempts to do this have started [31], although this type of modelling is certainly not ready for routine clinical application at present. Whatever model is used can only be a reflection of the input data, for example, much of the long-term outcome data is derived from older studies using more extensive radiation fields [29].…”

Closing the survivorship gap in children and adolescents with Hodgkin lymphoma

“…These range from acute to late toxicity, risk of relapse and risk of late effects. A dynamic decision model for patients with early stage HL provides a proof of principle that incorporating contemporary trial‐based probabilities of transition through health states (from diagnosis through treatment and survivorship) and applying utility weights estimating HRQoL can be useful (Parsons et al , ). Harmonization of individual level data from contemporary trials across many cooperative groups is ongoing to further refine and test this model across age and risk groups.…”