Management of Hodgkin's disease in Western India

Abstract

The authors report a retrospective analysis of 441 patients with Hodgkin's disease seen at the Tata Memorial Hospital, Bombay, over a 4‐year period from 1975 to 1978. Clinicopathologic features seem to vary from those reported in the western literature, but are similar to the patterns observed in Africa and South America. Thirty‐three percent of all malignant lymphomas were Hodgkin's disease. Histologically, the mixed cell (MC) type (40%) and the lymphocytic predominant (LP) type (24%) were the most common, with 52% of patients presenting in Stages III and IV. The nodular sclerosis (NS) variant occurred in only 11% of the cases. Systemic symptoms were present in 24% of clinical Stage I patients, and increased steadily to 85% in Stage IV patients. Bone marrow biopsies in 242 patients were found to be of little value in Stages I and II. Thirty of 34 patients with positive bone marrow biopsy were in clinical Stages III B and IV, whereas 24 of 34 patients showed MC and LD patterns. Lymphangiography in 104 patients altered the clinical staging of Stages I and II in 27% of the cases with accuracy of 80%. Staging laparotomy performed in 93 patients altered the stage in 45% of clinical Stage I and 62% of Stage II patients. Splenic involvement was common in the presence of systemic symptoms (67%) and MC/LD histology (82%). The incidence of liver involvement was 16% in 15 patients with all, but one, associated with splenic pathology. The clinical stage and histopathologic variants of the disease bear an excellent correlation with a significant impact on treatment responses and total survival. The survival rates for Stage I were 81%, Stage II 76%, Stage IIIA 71%, and Stage IIIB and IV 46% at 48 months. The LP type had the best prognosis with 85% survival at 48 months, whereas the survival in the depleted variety was only 56%. Surprisingly, the MC type did better with a 64% survival, while the nodular sclerosis group had 59% surviving at 48 months.

Clinical profile and outcome of adult Hodgkin lymphoma: Experience from a tertiary care institution

“…Median age is slightly higher than in other studies as we have included patients from 19 years, and many Indian studies have included from 15 years. [ 8 16 ] Higher male to female ratio has also been reported in earlier studies from India[ 8 9 10 11 12 13 14 15 16 ] and other countries with limited resources. [ 20 ] In the present study, the clinical presentation is more or less similar to earlier studies.…”

“…[ 1 2 3 4 ] The outcome of HL in developed countries from the cancer registries are widely available,[ 5 6 7 ] few studies with small number of the patient are reported from the Indian subcontinent. [ 8 9 10 11 12 13 14 15 16 ] This is the first study from the state of Andhra Pradesh, attempting to add data to the existing literature. We have analyzed HL patients treated at our center over a 20-year period.…”

The relevance of a staging laparotomy for Hodgkin's disease in India

“…The most common histopathological types occurring in our region are the MC and LP types, as documented in earlier publications [7,8]. Thus the inclusion in this study of 42% of the MC and 38% of LP subtypes has clinical relevance.…”

“…Nearly one-half of our CS I and I1 patients who have presented without the unfavourable symptoms associated with stage B, have been found to have unsuspected disease below the diaphragm. This is rather high compared to the Western disease pattern and, the clinical implication is obvious in view of the fact that nearly 50% of our patients would initially present in these early stages, as shown by Dinshaw et al in a recent review [7].…”

MOPP chemotherapy plus irradiation for Hodgkin's disease, stages IA TO IIIB. Long‐term results of the prospective trial H72 (1972–1976, 334 patients)

“…Table 4 gives ouf estimation of the different types of relapse and mortality rates following the different treatment strategies (radiation therapy alone or combined with chemotherapy) of early HD. Some authors (Anaveri et al, 1984, O'Dwyer et al, 1984, Pavlovsky et al, 1984 recently advocated the use of MOPP alone for treating early stages of HD; if such a strategy is valid in underdeveloped countries lacking radiotherapy facilities (Olweny et al, 1978, Dinshaw et al, 1984, it seems to be criticable in western countries: 10-15 per cent of the patients do not enter complete remission after MOPP chemotherapy and need irradiation to have a chance of complete remission and cure; the other reason is a relapse rate of 20 per cent after MOPP alone in these early stages (Colonna and Andrieu, 1985). In these conditions, the disease-free survival does not exceed 7&85 per cent whereas it is higher with irradiation alone or combined with chemotherapy.…”