Abstract
Background: Hodgkin’s disease is a curable malignant disease. Despite advances in the management of this disease entity, there are groups of patients who suffer relapse and identification of prognostic variables and adaptation of treatment to individual risk remains a major challenge. Emphasized in this study are the clinicopathological characteristics and outcome of Hodgkin’s lymphomas.
Materials and Methods: A retrospective analysis of 245 adult patients treated for Hodgkin’s lymphoma between October 1990 and Dec 2004 was done. An analysis of the most important variables was made in terms of both disease free and overall survival. Spectrums of pretreatment factors were evaluated including International Prognostic Factors, extranodal disease symptoms, histology, and bulky disease. Patients were treated with chemotherapy, radiotherapy either alone or in combinations at the beginning and relapses was treated with various salvage regimes combined with radiotherapy and stem cell transplant.
Results: The median age in this study group was 32 years (14–72) and 156(63.67%) were male. Distribution by stages were: stage I-43, stage II-113, stage III-44, and stage IV-45.Pathological subtypes were Nodular sclerosis-128, Mixed cellularity-56,Lymphocyte rich classical-13,Lymphocyte depletion-7,and nodular lymphocyte predominance-29,not specified in 12.B symptoms observed in 95,bulky in 72 and Extra nodal involvement in 63 patients. Complete remission was achieved in 226 patients with first line management (92.24%).Primary chemo refractory (19) and relapses were observed in 72 patients, and subsequent salvage chemotherapy including stem cell transplant (28 patients) resulted CR in 41.With the median follow up of 41months (1-374), OS was 95% and DFS was 87%.Twelve patients died out of which 8 due to disease recurrence or progression.
Conclusions: Achieving a complete remission shows a favorable prognosis for prolonged DFS. StageIV, bulky disease,B symptoms, extra nodal involvement and NS histology were associated with inferior OS and DFS. Additional factors for poor DFS were male sex, hypoalbumenemia and anemia. Age and leucocytosis did not affect the outcome. Identifying the pretreatment risk factors may be useful in designing clinical trials for the treatment of relapsed and refractory Hodgkin’s disease and in making individual therapeutic decisions.
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