Genç Erişkin Klasik Hodgkin Lenfomada Progresyonsuz Sağkalım Ve Erken Yanıt Öngörücülerinin Analizi

Year 2025, Volume: 7 Issue: 3, 341 - 349, 13.10.2025

Tuğcan Alp Kırkızlar , Erge Aslan , Ahmet Yigitbasi , Hakkı Onur Kırkızlar , Elif Umit , Ahmet Muzaffer Demir

https://doi.org/10.52827/hititmedj.1652673

Abstract

Amaç: Klasik Hodgkin lenfoma (HL) ergen-genç erişkin yaş grubunda (EGE) sık görülen bir malignitedir. Bu yaş grubu diğer yaş gruplarına göre biyolojik, klinik ve psikososyal farklılıklara sahip olduğundan EGE grubu olarak ifade edilmektedir.
Biz de bu çalışmayla merkezimizdeki genç erişkin grupta Klasik HL tanılı olgularımızı değerlendirmeyi, ara değerlendirmede tam yanıtın (TY-erken yanıt) ve progresyonsuz sağkalım (PFS) öngörücülerini belirlemeyi amaçladık.
Gereç ve Yöntemler: 2015-2023 tarihleri arasında merkezimizde klasik HL tanısı alarak tedavi ve izlemi yapılan 18-39 yaş grubundaki hastalar retrospektif olarak incelendi.
Bulgular: 54 hastanın ortanca yaşı 30 yıl ve %53,7’i kadındı. En sık alt tip nodüler sklerozan (%61,1) olup hastaların %40’ı tanıda evre II ve %51,9’u ileri evreydi. Erken evre hastaların %53,8’i olumsuz risk grubundayken ileri evre hastaların %46,4’ve %7,1’i orta ve yüksek riske sahipti. 1. basamak tedavide hastaların %92,6’sına ABVD protokolü uygulanmıştı. Ara değerlendirmede TY oranı %66,1 iken tedavi sonunda TY oranı %88 idi.
Ortanca 47,5 aylık izlem sürecinde mortalite oranı %3,7 idi. Ortalama toplam sağkalım süresi 107.407 (3.16) (%95 CI) aydı. Ortalama PFS süresi 83,5 ay olup, erken yanıt sağlanan ve sağlanamayan gruplar arasında istatiksel fark bulunmadı (p= 0.197). PFS ve ara değerlendirmede TY öngörücüleri multivariate analizlerde incelendiğinde anlamlı değişken saptanmadı.
Sonuç: Çalışmamızda sonuçlarımız literatürle benzerlik göstermekte olup, tamamına yakınına ABVD protokolü uygulanan hasta grubumuzda sağkalım ve tedavi yanıt oranları da yüz güldürücüdür. Hastaların tedavi yaklaşımı ve izleminde katkı sağlayabilecek PFS ve erken TY öngörücüleri incelenmiş ancak anlamlı değişkenler saptanamamıştır. Bunun yanında erken TY sağlanmasının PFS farkı anlamlı bulunmamıştır.

Keywords

Hodgkin lenfoma , genç erişkin , progresyonsuz sağkalım , yanıt

Ethical Statement

Çalışma için 21/10/2024 tarihinde Trakya Üniversitesi Tıp Fakültesi Girişimsel Olmayan Araştırmalar Etik Kurulu’ndan onay alınmıştır. Karar no: 17/09.

Analysis of Predictors of Progression-Free Survival and Early Response in Young Adult Classical Hodgkin Lymphoma

Abstract

Objective: Classical Hodgkin lymphoma (HL) is a common malignancy among adolescents and young adults (AYA). As this age group has biological, clinical and psychosocial differences compared to other age groups, it is referred to as the AYA group. The present study aimed to evaluate young adult patients diagnosed with classical HL at our center and identify predictors of complete response (CR) at interim evaluation and progression-free survival (PFS).
Material and Method: Patients aged 18-39 years diagnosed with classical HL who were treated and followed up at our centre between 2015 and 2023 were retrospectively analysed.
Results: The median age of 54 patients was 30 years and 53,7% were female. The most common subtype was nodular sclerosis (61,1%), with 40% of patients in stage II and 51,9% in advanced stages at diagnosis. Among early-stage patients, 53.8% were categorized as unfavorable risk, whereas 46.4% and 7.1% of advanced-stage patients were classified as intermediate and high risk, respectively. In the first- line treatment, 92,6% of patients were treated with the ABVD protocol. At the interim evaluation, the CR rate was 66,1%, while the CR rate at the end of treatment was 88%.
The mortality rate was 3,7% during a median follow-up of 47,5 months. The mean overall survival was 107.407 (3.16) (95% CI) months. The mean PFS was 83,5 months, with no statistically significant difference between the early CR and non-CR groups (p = 0.197). When the predictors of PFS and CR at interim assessment were analysed in multivariate analyses, no significant variables were found.
Conclusion: In our study, our results are similar to the literature and the survival and response rates in patient population, almost all of whom were on the ABVD protocol, are also encouraging. Despite analyzing potential predictors of PFS and early CR for guiding treatment and follow-up, no significant factors were identified. Furthermore, achieving early CR did not significantly impact PFS.

Keywords

Hodgkin lymphoma , young adults , progression-free survival , response

Ethical Statement

Approval for the study was obtained from the Trakya University Faculty of Medicine Non-Interventional Research Ethics Committee on 21/10/2024. Decision no: 17/09.

References

• Medeiros LJ, Greiner TC. Hodgkin’s disease. Cancer 1995;75:357- 369.
• Campo E, Jaffe ES, Cook JR, et al. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood 2022;140:1229-1253.
• Alaggio R, Amador C, Anagnostopoulos I, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia 2022;36:1720-1748.
• Jachimowicz RD, Engert A. The challenging aspects of managing adolescents and young adults with Hodgkin’s lymphoma. Acta Haematol 2014;132:274-278.
• Henderson TO, Parsons SK, Wroblewski KE, et al. Outcomes in adolescents and young adults with Hodgkin lymphoma treated on US cooperative group protocols: An adult intergroup (E2496) and Children’s Oncology Group (COG AHOD0031) comparative analysis. Cancer 2018;124:136-144.
• Bhuller KS, Zhang Y, Li D, et al. Late mortality, secondary malignancy and hospitalisation in teenage and young adult survivors of Hodgkin lymphoma: report of the Childhood/Adolescent/Young Adult Cancer Survivors Research Program and the BC Cancer Agency Centre for Lymphoid Cancer. Br J Haematol 2016;172:757-768.
• Akay OM, Birtaş Ateşoğlu E, Mehtap Ö, Salim O. Hodgkin Lenfoma. Türk Hematoloji Derneği Lenfoma Tanı ve Tedavi Kılavuzu içinde, Galenos Yayınevi, İstanbul 2020, 2-23.
• Lister TA, Crowther D, Sutcliffe SB, et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol 1989;7:1630-1636.
• Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014;32:3059-3068.
• André MPE, Girinsky T, Federico M, et al. Early Positron Emission Tomography Response-Adapted Treatment in Stage I and II Hodgkin Lymphoma: Final Results of the Randomized EORTC/LYSA/FIL H10 Trial. J Clin Oncol 2017;35:1786-1794.
• Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 1998;339:1506-1514.
• https:// www.seer.cancer.gov. Cancer stat facts/Hodgkin lymphoma (Last access: 18.03.2025)
• Zawati I, Adouni O, Finetti P, et al. Adolescents and young adults with classical Hodgkin lymphoma in northern Tunisia: insights from an adult single-institutional study. Cancer Radiother 2020;24:206-214.
• Kendel NE, Stanek JR, Willen FK, Audino AN. Characterizing age-related differences in Hodgkin lymphoma in children, adolescents and young adults. Pediatr Hematol Oncol 2024;41:336-345.
• Berkman AM, Andersen CR, Puthenpura V, et al. Impact of Race, Ethnicity, and Socioeconomic Status over Time on the Long-term Survival of Adolescent and Young Adult Hodgkin Lymphoma Survivors. Cancer Epidemiol Biomarkers Prev 2021;30:1717-1725.
• Foltz LM, Song KW, Connors JM. Hodgkin’s lymphoma in adolescents. J Clin Oncol 2006;24:2520-2526.
• Eichenauer DA, Bredenfeld H, Haverkamp H, et al. Hodgkin’s lymphoma in adolescents treated with adult protocols: a report from the German Hodgkin study group. J Clin Oncol 2009;27:6079-6085.
• Marr KC, Connors JM, Savage KJ, Goddard KJ, Deyell RJ. ABVD chemotherapy with reduced radiation therapy rates in children, adolescents and young adults with all stages of Hodgkin lymphoma. Ann Oncol 2017;28:849-854.