Primary therapy and relative survival in classical Hodgkin lymphoma: a nationwide population-based study in the Netherlands, 1989–2017

Abstract

Population-based studies of classical Hodgkin lymphoma (cHL) in contemporary clinical practice are scarce. The aim of this nationwide population-based study is to assess trends in primary therapy and relative survival (RS) during 1989-2017. We included 9,985 patients with cHL. Radiotherapy alone was virtually not applied as from 2000 among patients aged 18-69 years with stage I/II disease, following the broader application of chemotherapy combined with radiotherapy. Chemotherapy only was the preferred treatment for patients with stage III/IV disease. Throughout the entire study period, around 20% of patients aged ≥70 years across all disease stages received no anti-neoplastic therapy. The most considerable improvements in 5-year RS were confined to patients aged 18-59 years. Five-year RS for patients with stage I/II disease diagnosed during 2010-2017 was 99%, 98%, 100%, 93%, 84%, and 61% for patients aged 18-29, 30-39, 40-49, 50-59, 60-69, and ≥70 years, respectively. The corresponding estimates for stage III/IV disease were 96%, 92%, 90%, 80%, 58%, and 46%. Collectively, the improvements in survival likely relate to advances in cHL management. These achievements, however, do not seem to translate into significant benefits for patients ≥60 years. Therefore, novel therapies are urgently needed to reduce excess mortality in elderly cHL patients.

Time trends in primary therapy and relative survival of diffuse large B-cell lymphoma by stage: a nationwide, population-based study in the Netherlands, 1989–2018

“…The incidence of stage II–IV DLBCL gradually increased over time, following a slight decrease of stage I disease as of the mid-2000. This finding is congruent with recent epidemiological studies in other lymphomas [ 32 , 33 ]. The gradual implementation of PET-CT in the early 2000s likely explains this phenomenon, resulting in stage migration and a decrease of unstaged patients because PET-CT more accurately detects nodal and extranodal lesions than CT alone [ 34 , 35 ].…”

Guideline for the first‐line management of Classical Hodgkin Lymphoma — A British Society for Haematology guideline

“…Patients aged over 60 account for approximately 20% of cases of HL 53,54 . Older patients have poorer outcomes, especially with advanced‐stage disease 54‐59 and this has not improved with time 60 . Older patients are more likely to die from non‐lymphoma causes, including bleomycin lung toxicity and treatment with ABVD and eBEACOPP is challenging.…”

“…53,54 Older patients have poorer outcomes, especially with advanced-stage disease [54][55][56][57][58][59] and this has not improved with time. 60 Older patients are more likely to die from nonlymphoma causes, including bleomycin lung toxicity and treatment with ABVD and eBEACOPP is challenging. The major trials included small numbers of elderly patients and there have been few prospective trials for older patients.…”

Subtyping on Live Lymphoma Cell Lines by Raman Spectroscopy

“…Classical Hodgkin lymphoma (cHL) and mantle cell lymphoma (MCL) are both heterogeneous B-cell derived lymphomas, with distinctive clinical presentation, histological and molecular signatures. cHL, one of the two major categories of Hodgkin lymphoma (HL) accounting for approximately 30% of all lymphomas [5], is considered as a highly curable malignancy, however this is not the case for elderly patients [6]. Mantle cell lymphoma (MCL), a rare and typically aggressive form of NHL representing about 3-10% of adult-onset NHL in Western countries, is often diagnosed at a late stage during biopsy [7].…”