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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MSK Authors
  1. Joachim Yahalom
    457 Yahalom
  2. Shunan Qi
    9 Qi