Treating Hodgkin Lymphoma without Dacarbazine: A Lesson Learned from Thailand

Suwanban, Tawatchai; Nakhakes, Chajchawan; Lekhakula, Arnuparp; Julamanee, Jakrawadee; Norasetthada, Lalita; Nawarawong, Weerasak; Chansung, Kanchana; Sirijerachai, Chittima; Khuhapinant, Archrob; Siritanaratanakul, Noppadol; Bunworasate, Udomsak; Intragumtornchai, Tanin; Numbenjapon, Tontanai; Prayongratana, Kannadit; Nipharuck, Pimjai; Chuncharunee, Suporn; Wongkhantee, Somchai; Wong, Peerapon; Kanitsap, Nonglak; Pornuipavee, Rachanid; Makruasi, Nisa

doi:10.1182/blood.V126.23.5002.5002

Abstract

INTRODUCTION: Hodgkin lymphoma (HL) is curable if the patients are treated early and properly. Thailand is a country where public health care resources are limited and as such, dacarbazine was not listed in the national drug list, thus, cannot be reimbursed in patients under the Universal Coverage payment scheme which comprised 60-70% of all patients. This study was aimed to compare outcome differences between patients with HL who were treated with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), ABV (doxorubicin, bleomycin, vinblastine) and COP/ABV (cyclophosphamide, vincristine, prednisolone, procarbazine /ABV) as happened in the real world practice in Thailand.

METHODS: From the nationwide multicenter registry of 4,371 newly diagnosed lymphoma patients in Thailand from 2007 to 2014, there were 316 patients with HL. The data is part of the Thai Lymphoma Study Group Registry performed at the thirteen major medical centers in Thailand. The patients' characteristics, treatment options and outcomes were analyzed.

RESULTS: The median age was 42 years (range,13-89 years). Male: female was 1.3:1. Fifteen percent of the patients were older than 60 years. Histological subtypes were classical HL, nodular sclerosis, 45.3%, mixed cellularity, 28.6%, lymphocytic rich, 3.5%, lymphocytic depletion 5.1%, nodular lymphocytic predominant, 7.5% and unclassifiable, 10.5%. Fifty percent of patients were stage III/IV and 46% had B symptoms. Clinical characteristics were not significantly different between patients treated with ABVD, ABV and COP/ABV (Table 1). Treatment options were varied according to doctors' preference, hospital strategy and the reimbursement policy. ABVD was the most common prescribed regimen (32.7%); the other options included ABV (29.2 %), COP/ABV (13.1 %), CHOP (2.8 %) and radiotherapy only (1.6%). With a median follow-up of 32 months, patients treated with ABVD had superior 5 year overall survival rate over those treated with ABV (86.6% vs 47.7%, p < 0.001) and COP/ABV (86.6% vs 62.7%, p < 0.01)(Figure 1). Discrepancies in survivals could be demonstrated both in patients with limited as well as in advanced diseases (Figure 2).

CONCLUSION: ABVD yielded superior survival compared to ABV and COP/ABV. Dacarbazine is therefore an essential drug for the treatment of HL in developing countries.

Figure 1.