Overview and outcome of Hodgkin’s Lymphoma: Experience of a single developing country’s oncology centre
April
Overview and outcome of Hodgkin's Lymphoma: Experience of a single developing country's oncology centre
Rawand P. Shamoon 0 1
Mohamad Dahir Ali 1
Nazar P. Shabila 1
0 Department of Pathology, College of Medicine, Hawler Medical University , Erbil , Iraq , 2 Department of Haematopathology, Nanakali Haemato-Oncology Teaching Centre, Erbil, Iraq, 3 Department of Clinical Haematology, Nanakali Hemato-Oncology Teaching Centre, Erbil, Iraq, 4 Department of Community Medicine, Hawler Medical University , Erbil , Iraq
1 Editor: Francesco Bertolini, European Institute of Oncology , ITALY
Hodgkin's Lymphoma (HL) reveals variable epidemiological and clinico-pathological features in different geographical locations. In this retrospective study, we aimed to assess the epidemiological and clinic-pathological features, and outcome of HL patients treated at one hemato-oncology centre in Erbil, northern Iraq. Medical records of 103 HL patients treated over more than six years were reviewed. Treatment outcome was evaluated by measuring the 5-year overall and progression-free survival rates. The median age of patients was 23 years, children up to 17 years constituted 31.1%, and male to female ratio was 1:1.05. The majority (96.1%) of patients presented with lymphadenopathy. Nodular sclerosis subtype was the mostly encountered histologic type (48.5%); about half of the patients (49.5%) had stage II disease. Relapse occurred in 20 patients; the 5-year overall survival for children was better (89%) compared to adult patients (79%). The associated risk features found to have adverse effects on the survival, however, only high LDH level and presence of B-symptoms at presentation showed significant correlation. The epidemiological and clinical characteristics of HL in our locality followed the pattern in the western world. The 5-year overall and progression-free survivals were far below the international rates, a matter which may necessitate a revision to HL treatment strategy at our centre.
-
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
file.
Funding: The authors received no specific funding
for this work.
Competing interests: The authors have declared
that no competing interest exist.
Introduction
Hodgkin Lymphoma (HL) is an uncommon tumour, although it is one of the more frequent
malignancies in young people. Its annual incidence is 2±3 per 100,000 in Europe and the USA;
though it accounts for 5±6% of all childhood cancer. There are variations in the epidemiologic
and clinico-pathological characteristics of HL in relation to geography and socioeconomic
status. In the industrialised countries, HL has a bimodal incidence with the main peak in young
adults of 15±35 years and the second one occurring after the age of 50. On the other hand, the
disease appears more in young children in the developing countries. Males are affected more
often than females in all subtypes; however, the nodular sclerosing type occurs slightly more
often in young females [
1,2
].
HL is considered as one of the malignant diseases that respond well to treatment. With
continuing clinical trials and combination therapy over the last 30 years, survival rates have been
continuously raised. The improvement in patients' survival is mainly remarkable in the
paediatric age and low risk groups [3±6]. Fortunately, the success story of HL is not restricted to the
developed world; promising rates of survival have been reported from many developing areas
[7±11]. Reducing short and long-term toxicity with maintaining excellent cure rates has
become the principal objective of the recent trials in the developed part of the world [
12,13
].
This attempt may be difficult in our setting where patients, as well as physicians, often choose
certainty of cure over the risk of late effect.
In our centres, and like the case in some other centres in the developing world, HL patients
are principally treated with extensive cycles of ABVD (Doxorubicin, Bleomycin, Vinblastine,
and Dacarbazine) chemotherapy. There are increased reports of promising survival rates of
HL (80±95%) in the last two decades [14±16]. However, there is lack of outcome data about
HL patients who have been treated at our centre. Therefore, we deemed necessary to review
and study our records to assess the quality of care and the effectiveness of the treatment
protocols applied at our centre. Hence, this study aimed to describe the demographic and
clinicopathological aspects of patients with HL, assess the 5-year overall (OS) and progression-free
survival (PFS) rates of paediatric and adult patients, and evaluate the effect of the associated
unfavourable risk factors on patients' survival.
Patients and methods
This retrospective study was carried out at Nanakali Hemato-Oncology Teaching Centre in
Erbil. Nanakali Centre is a 100-bed public hospital that receives paediatric and adult patients
with benign and malignant haematology diseases and (...truncated)