Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov;24(11):1488-1495.
doi: 10.1634/theoncologist.2019-0172. Epub 2019 Aug 29.

Contemporary Outcomes for Advanced-Stage Classical Hodgkin Lymphoma in the U.S.: Analysis of Surveillance, Epidemiology, and End Results Database

Guru Subramanian Guru Murthy  1 , Aniko Szabo  2 , Mehdi Hamadani  1   3 , Timothy S Fenske  1 , Nirav N Shah  4
Affiliations

Contemporary Outcomes for Advanced-Stage Classical Hodgkin Lymphoma in the U.S.: Analysis of Surveillance, Epidemiology, and End Results Database

Guru Subramanian Guru Murthy et al. Oncologist. 2019 Nov.

Abstract

Background: Advanced-stage Hodgkin lymphoma (HL) is a curable malignancy, although outcomes remain poor in certain patients. It remains unclear if recent advances have improved their population-level survival over time.

Materials and methods: Using the Surveillance, Epidemiology, and End Results database, we identified patients aged ≥18 years with stage III or IV classical HL as the first primary malignancy, diagnosed between 2000 and 2014 and treated with chemotherapy. Patients were stratified by date of diagnosis into three groups (2000-2004, 2005-2009, 2010-2014) to assess the trends in overall survival (OS).

Results: A total of 9,042 patients with a median age of 41 years were included. The use of frontline radiation therapy decreased in each period (21.3% [2000-2004] vs. 15.5% [2005-2009] vs. 10.7% [2010-2014]; p < .001). Three-year OS was significantly higher for patients diagnosed between 2010 and 2014 (81.8%) and 2005 and 2009 (80.6%) compared with 2000 and 2004 (78.5%; p = .0008 and .02, respectively). Whereas outcomes were poorest in the age >60 cohort, similar improvements were also seen in 3-year OS over the three time periods within this patient population. On multivariate analysis, diagnosis in the earlier period and minority race were associated with higher mortality. Females and married patients had significantly lower mortality risk.

Conclusion: Survival of patients with advanced-stage HL has continued to improve over time, suggesting the impact of evolving treatment approaches. Three-year OS in the contemporary period remains inadequate at 81.8%, highlighting the need for continued research to improve their outcomes.

Implications for practice: This article evaluates contemporary outcomes for advanced-stage Hodgkin lymphoma (HL) in the U.S. using the Surveillance, Epidemiology, and End Results database. Although overall survival (OS) has improved in each 5-year period since 2000, the 3-year OS from 2010 to 2014 remains inadequate at 81.8% and is limited by patient demographics. New therapies are indicated to improve clinical outcomes in advanced-stage HL.

Keywords: Disparities; Hodgkin; Lymphoma; Surveillance, Epidemiology, and End Results database; Survival.

PubMed Disclaimer

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Overall survival by period of diagnosis.
Figure 2.
Figure 2.
Overall survival by age at diagnosis.
Figure 3.
Figure 3.
Estimated effect of the period of diagnosis within subgroups of patients. Abbreviation: RT, radiation therapy.
Figure 4.
Figure 4.
Estimated effect of age at diagnosis in the Cox regression model.
See this image and copyright information in PMC

References

    1. National Cancer Institute. Cancer Stat Facts: Hodgkin Lymphoma. https://seer.cancer.gov/statfacts/html/hodg.html. Accessed November 15, 2018.
    1. Canellos GP, Rosenberg SA, Friedberg JW et al. Treatment of Hodgkin lymphoma: A 50‐year perspective. J Clin Oncol 2014;32:163–168. - PubMed
    1. Connors JM, Jurczak W, Straus DJ et al. Brentuximab vedotin with chemotherapy for stage III or IV Hodgkin's lymphoma. N Engl J Med 2018;378:331–344. - PMC - PubMed
    1. Koshy M, Fairchild A, Son CH et al. Improved survival time trends in Hodgkin's lymphoma. Cancer Med 2016;5:997–1003. - PMC - PubMed
    1. Bessell EM, Bouliotis G, Armstrong S et al. Long‐term survival after treatment for Hodgkin's disease (1973‐2002): Improved survival with successive 10‐year cohorts. Br J Cancer 2012;107:531–536. - PMC - PubMed