Two distinct prognostic groups in advanced-stage Hodgkin lymphoma revealed by the presence and site of bulky disease Journal Article
| Authors: | Qi, S.; Milgrom, S.; Dabaja, B.; Tsang, R.; Levis, M.; Ricardi, U.; Lopez-Alonso, R.; Dann, E. J.; Ng, A.; Yahalom, J. |
| Article Title: | Two distinct prognostic groups in advanced-stage Hodgkin lymphoma revealed by the presence and site of bulky disease |
| Abstract: | Controversy exists regarding the definition and prognostic significance of bulk in advanced-stage (stage III/IV) Hodgkin lymphoma (ASHL), and bulk location (mediastinum vs other sites) further complicated the setting. This retrospective, multi-institutional study comprised 814 ASHL patients between 2000 and 2010 and aimed to evaluate the significance of bulk in ASHL. End points of interest included progression-free survival (PFS) and overall survival (OS). Covariates included maximum diameter and the site of bulky disease. SmoothHR and Kaplan-Meier analyses were used to assess for an association of PFS and OS with covariates. In the exploratory cohort (n 5 683), maximum diameter had no association with PFS and a complex, U-shaped association with all-cause mortality on smoothHR analysis. Using 5 cm as a cutoff for bulk, Kaplan-Meier analyses confirmed the smoothHR results. The site of bulk was incorporated to divide patients into 2 groups. The mediastinal bulk (MB) type had more favorable characteristics than the nonbulky/non-MB (NB/NMB) type on age, histology, and bone marrow involvement (P, .001). The MB type was associated with better OS than the NB/NMB-type on univariable analysis (5-year OS, 92% vs 86%; HR, 0.53; 95% confidence interval, 0.34-0.84; P 5 .007). These findings persisted in the subgroup treated with chemotherapy alone and were confirmed in an independent validation cohort (n 5 131). Our findings indicate that mediastinal bulk was associated with more favorable disease characteristics and improved OS in ASHL, and may be a surrogate of a more favorable biology. © 2020 by The American Society of Hematology |
| Journal Title: | Blood Advances |
| Volume: | 4 |
| Issue: | 9 |
| ISSN: | 2473-9529 |
| Publisher: | American Society of Hematology |
| Date Published: | 2020-05-12 |
| Start Page: | 2064 |
| End Page: | 2072 |
| Language: | English |
| DOI: | 10.1182/bloodadvances.2019001265 |
| PUBMED: | 32396621 |
| PROVIDER: | scopus |
| PMCID: | PMC7218436 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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