Overview and outcome of Hodgkin’s Lymphoma: Experience of a single developing country’s oncology centre

PLOS ONE, Nov 2019

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.

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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)


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Rawand P. Shamoon, Mohamad Dahir Ali, Nazar P. Shabila. Overview and outcome of Hodgkin’s Lymphoma: Experience of a single developing country’s oncology centre, PLOS ONE, 2018, Volume 13, Issue 4, DOI: 10.1371/journal.pone.0195629