Hodgkin Lenfomalı Hastalarımızın Klinik ve Laboratuvar Özelliklerinin Değerlendirilmesi: Tek Merkez Deneyimi

Öz

Çalışmamızda kliniğimizde Ocak 2008-Aralık 2018 tarihleri arasında, Hodgkin lenfoma (HL) tanısı alan hastaların; demografik, histopatolojik, prognostik özelliklerini belirlemeyi ve bu belirteçlerin sağkalım üzerindeki ilişkisini ortaya koymayı amaçladık. Çalışmamızda Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Hematoloji Bilim Dalı’nda 2008-2018 yılları arasında, Dünya Sağlık Örgütü (WHO) 2008 sınıflamasına göre Hodgkin lenfoma tanısı almış olan 130 hastanın verileri retrospektif olarak değerlendirildi. Çalışmaya dahil edilen 130 hastanın %61.5’i (n=80) erkek, yaş ortalaması 46.5±15.8 (20-89) yıldı. Tanı sırasında hastaların %37.7’si erken evre, %62.3’ü ileri evreydi. En sık tanı evre Ⅱ’de (%34.6) konulmuştu. Hastalardan %93.1’i klasik HL, %6.9’u nodüler lenfosit predominant HL tanısı almıştı. Klasik HL tanılı hastaların %49.6’si nodüler sklerozan HL (NSHL), %15.7’si mikst selüler HL, %7.4 lenfositten zengin HL, %3.3’ü lenfositten fakir HL tanılıydı, %24 ise klasik HL tanılı ancak alt tipi belirtilmemişti. NSHL tüm hastalarda, kadınlarda ve erkeklerde en sık görülen histolojik alt gruptu. Evrelere göre genel sağkalım (OS) ve relapssız sağkalımlara (RFS) bakıldığında evre Ⅰ’de en yüksek, evre Ⅳ’te en düşüktü. Tüm hastalara göre bakıldığında 5 yıllık OS %88.7, 5 yıllık RFS %83.9, 10 yıllık OS %82.2, 10 yıllık RFS %82.4 olarak bulundu. Prognostik faktörlerin değerlendirilmesinde yaş (p=0.001), ekstranodal tutulum (p=0.007), kemik iliği tutulumu (p=0.05), ECOG performans skoru (p<0.001), B semptom varlığı (p=0.049), hemoglobin (p<0.0001), albümin (p<0.0001), alkalen fosfatazın (ALP) (p=0.0001) tek değişkenli analizde, mortalite üzerine anlamlı etkisi olduğu görüldü. Çok değişkenli analizde yaş (p<0.001), albümin (p=0.041), ALP (p=0.005), lökosit sayısı (p=0.028) prognostik faktörler olarak saptandı. Hastaların çoğu tanıda ileri evrede olup, 5 ve 10 yıllık genel ve relapssız sağkalımları evre arttıkça azalmaktadır. Yaş, ekstranodal tutulum, kemik iliği tutulumu, ECOG performansı, B semptom varlığı, anemi, hipoalbüminemi, ALP ve lökosit sayısı genel sağkalım üzerine etkili prognostik faktörlerdir.

Anahtar Kelimeler

• Hodgkin lenfoma
• prognostik özellikler
• klinik özellikler

Evaluation of Clinical and Laboratory Characteristics of Our Patients with Hodgkin Lymphoma: A Single Center Experience

Öz

In our study, patients diagnosed with Hodgkin lymphoma (HL) between January 2008 and December 2018 in our clinic; We aimed to determine demographic, histopathological and prognostic features and to reveal the relationship of these markers on survival. In our study, the data of 130 patients who were diagnosed with Hodgkin lymphoma in Eskişehir Osmangazi University Faculty of Medicine Hematology Department between 2008-2018 according to the World Health Organization (WHO) 2008 classification were analyzed retrospectively. 61.5% (n = 80) of the 130 patients included in the study were male, the mean age was 46.5 ± 15.8 (20-89) years. At the time of diagnosis, 37.7% of the patients were in the early stage and 62.3% were in the advanced stage. The most common diagnosis was made in stage (34.6%). 93.1% of the patients were diagnosed with classical HL and 6.9% with nodular lymphocyte predominant HL. Of the patients with classic HL, 49.6% were diagnosed with nodular sclerosing HL (NSHL), 15.7% with mixed cellular HL, 7.4% with lymphocyte-rich HL, 3.3% with lymphocyte-poor HL, 24% with classic HL but no subtype specified. NSHL was the most common histological subgroup in all patients, women, and men. Looking at overall survival (OS) and relapse-free survival (RFS) by stages, it was highest in stage Ⅰ and lowest in stage Ⅳ. Considering all patients, 5-year OS was 88.7%, 5-year RFS was 83.9%, 10-year OS was 82.2%, 10-year RFS was 82.4%. In the evaluation of prognostic factors, age (p = 0.001), extranodal involvement (p = 0.007), bone marrow involvement (p = 0.05), ECOG performance score (p <0.001), presence of B symptoms (p = 0.049), hemoglobin (p <0.0001) ), albumin (p <0.0001), alkaline phosphatase (ALP) (p = 0.0001) were found to have a significant effect on mortality in univariate analysis. In multivariate analysis, age (p <0.001), albumin (p = 0.041), ALP (p = 0.005), leukocyte count (p = 0.028) were determined as prognostic factors. Most of the patients are at advanced stage at diagnosis, and their overall and relapse-free survival of 5 and 10 years decreases as the stage increases. Age, extranodal involvement, bone marrow involvement, ECOG performance, presence of B symptoms, anemia, hypoalbuminemia, ALP and leukocyte count are prognostic factors that affect overall survival.

Anahtar Kelimeler

• Hodgkin lymphoma; prognostic factors; clinical features

Kaynakça

1. 1. Ansell SM, editor Hodgkin lymphoma: diagnosis and treatment. Mayo Clinic Proceedings; 2015: Elsevier.
2. 2. Kharazmi E, Fallah M, Pukkala E, Olsen JH, Tryggvadottir L, Sundquist K, et al. Risk of familial classical Hodgkin lymphoma by relationship, histology, age, and sex: a joint study from five Nordic countries. Blood. 2015;126(17):1990-5.
3. 3. Hjalgrim H, Askling J, Rostgaard K, Hamilton-Dutoit S, Frisch M, Zhang JS, et al. Characteristics of Hodgkin's lymphoma after infectious mononucleosis. N Engl J Med. 2003;349(14):1324-32.
4. 4. LaCasce AS, Ng AK. Hodgkin lymphoma: Epidemiology and risk factors.2020, UpToDate
5. 5. Meignan M, Gallamini A, Meignan M, Gallamini A, Haioun C. Report on the first international workshop on interim-PET scan in lymphoma. Leukemia & lymphoma. 2009;50(8):1257-60.
6. 6. Memiş Y, Kandaz M, Serdar L, Aynaci Ö, Şahbaz A, Soydemir G, et al. Hodgkin lenfomalı hastaların klinik özellikleri ve tedavi sonuçlarının geriye dönük analizi: Tek merkez deneyimi. Turkish Journal of Oncology/Türk Onkoloji Dergisi. 2015;30(2).
7. 7. Oliveira DEd, Bacchi MM, Abreu ES, Niéro-Melo L, Bacchi CE. Hodgkin disease in adult and juvenile groups from two different geographic regions in Brazil: characterization of clinicopathologic aspects and relationship with Epstein-Barr virus infection. American Journal of Clinical Pathology. 2002:25-30.
8. 8. Teke HÜ, Akay M, Gündüz E, Çolak E, Gülbaş Z, Hodgkin Lenfoma Tanısı Alan 103 Olgunun Retrospektif Olarak Değerlendirilmesi. Osmangazi Tıp Dergisi. 2008;30:25-31.

9. 9. Altintaş A, Çil T, Kaplan Ma, Atay Ae, Işikdoğan A, Büyükbayram H, et al. Hodgkin Lenfoma Olgularımız: Klinik ve Patolojik Değerlendirme.2006;4 (16):165-171
10. 10. Gallamini A, Hutchings M, Ramadan S, editors. Clinical presentation and staging of Hodgkin lymphoma. Seminars in hematology; 2016: Elsevier.
11. 11. Even-Sapir E, Lievshitz G, Perry C, Herishanu Y, Lerman H, Metser U. Fluorine-18 fluorodeoxyglucose PET/CT patterns of extranodal involvement in patients with Non-Hodgkin lymphoma and Hodgkin's disease. Radiologic Clinics of North America. 2007;45(4):697-709.
12. 12. Johnson PW, Sydes MR, Hancock BW, Cullen M, Radford JA, Stenning SP. Consolidation radiotherapy in patients with advanced Hodgkin's lymphoma: survival data from the UKLG LY09 randomized controlled trial (ISRCTN97144519). Journal of Clinical Oncology. 2010;28(20):3352-9.
13. 13. Hutchings M, Loft A, Hansen M, Pedersen LM, Buhl T, Jurlander J, et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood. 2006;107(1):52-9.
14. 14. Cuccaro A, Bartolomei F, Cupelli E, Galli E, Giachelia M, Hohaus S. Prognostic factors in hodgkin lymphoma. Mediterr J Hematol Infect Dis. 2014;6(1):e201405