Factors that affect treatment selection in early-stage classical Hodgkin lymphoma

This study examined factors important in treatment selection for early-stage classical Hodgkin lymphoma. Researchers reported that cancer markers, age, and tumor location as well as gender, ethnicity, distance to facility, and type of insurance affected treatment selection.

Classical Hodgkin lymphoma is the most common form of Hodgkin lymphoma and considered very treatable. The standard treatment for classical Hodgkin lymphoma is a combination of radiation and chemotherapy. They are usually administered one after the other. This is referred to as combined-modality therapy (CMT). Because of the side effects associated with radiation, there is ongoing interest in identifying groups who can be cured with chemotherapy alone.

The aim of this study was to identify factors that affect treatment selection for early-stage classical Hodgkin lymphoma.

The records of 20,600 patients with early-stage classical Hodgkin lymphoma were analyzed. 49.5% of patients were treated with CMT. 50.5% of patients were treated with chemotherapy alone. On average, chemotherapy was started 27 days after diagnosis. Radiation was started on average 171 days after diagnosis.

The rate of patients receiving CMT declined from 59.4% in 2003 to 45.2% in 2011. This decline was most pronounced for women younger than 30 years.

Overall, the likelihood of be treated with CMT decreased with age. In the youngest group (aged 18 to 29 years), women were significantly less likely than men to receive CMT. CMT was less frequently used in patients with B symptoms (fever, night sweats, and weight loss), tumors underneath the diaphragm, and unfavorable cancer cells.

Black patients were significantly less likely to receive CMT compared to Caucasian patients. Having private health insurance significantly increased the likelihood of receiving CMT compared to no insurance or public health insurance. The use of CMT was lower when the distance to a treatment facility was more than 50 miles.

9,296 of patients were available for long-term follow-up (average 6.1 years). The 5-year overall survival rate (proportion who have not died from any cause since treatment) was 89.6%. 5-year relative survival (compared to expected survival in the general population) was 94.3%. After accounting for a number of factors, CMT was associated with improved overall survival (by 39%) and relative survival (by 58%) when compared to chemotherapy alone.

Researchers concluded that treatment selection for early-stage classical Hodgkin lymphoma was influenced by cancer markers, age, and tumor location as well as by gender, ethnicity, distance to facility, and type of insurance. Since CMT was associated better survival, certain patients may therefore be at a disadvantage.

Many different treatment centers were examined in this study. Treatment duration and administration likely varied across centers.