Early-Stage Unfavorable Hodgkin Lymphoma: Patient Characteristics in Real-World Oncology Data from the United States

Introduction: Real-world evidence in patients with early-stage unfavorable Classical Hodgkin Lymphoma (CHL) is limited. This study's aim was to estimate the proportion of early favorable, early unfavorable, and advanced CHL patients and assess their demographic and clinical characteristics in a real-world setting.

Methods: This was a retrospective observational study. We identified newly diagnosed CHL cases between 1/1/2016 and 7/31/2021 from the ConcertAI Oncology Dataset which includes electronic medical records drawn from oncology clinics with 80% community vs 20% academic coverage across the US. All eligible patients were ≥18 years and required to have documented disease stage at initial CHL diagnosis. Patients were categorized as early favorable (stage I/II with no unfavorable factor), early unfavorable (stage I/II with any unfavorable factors), or advanced stage (stage III/IV) according to National Comprehensive Cancer Network (NCCN) guidelines.

Results: Of the total 324 patients who met eligibility criteria, over half of the cohort (n=166, 51.2%) was diagnosed with advanced CHL while 16.1% and 32.7% had early favorable and early unfavorable CHL, respectively. Patients with early unfavorable CHL were younger than their counterparts (median age 53.8 vs 34.8 early unfavorable vs 46.6 years advanced). The proportion of patients with stage II disease was higher in the early unfavorable cohort compared with the early favorable cohort (87.7% vs 69.2%). Patients with early unfavorable CHL had a larger nodal mass (mean 5.9 cm vs 5.3 cm advanced vs 4.4 cm early favorable). The percentages of patients with B symptoms (59.4%), bulky disease (46.2%), >3 involved lymph node regions (31.1%), and ESR ≥ 50 (25.5%) were higher in patients with early unfavorable CHL compared to other two groups. The primary treatment after initial diagnosis for early unfavorable CHL was bleomycin, dacarbazine, doxorubicin, vinblastine (ABVD) regimen (68.9%).

Conclusions: In this analysis of real-world data, we found that nearly one-third of newly diagnosed CHL patients had early unfavorable disease. Our analysis also showed differences in the magnitude of the proportion of patients for each unfavorable factor among patients with early-stage unfavorable CHL.

Gautam:Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA: Research Funding; Astellas: Research Funding; ConcertAI: Current Employment, Other: Medical publication support. Yeola:Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA: Research Funding. Nahar:Merck & Co., Inc.: Current Employment. Sarpong:Merck & Co., Inc.: Current Employment. Prescott:Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA: Current Employment, Current holder of stock options in a privately-held company. Yang:Merck & Co., Inc.: Current Employment. Sineshaw:Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA: Current Employment, Current holder of stock options in a privately-held company.