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Clinical Trial
. 2020 Jun;189(6):1093-1106.
doi: 10.1111/bjh.16491. Epub 2020 Feb 6.

Improved survival for adolescents and young adults with Hodgkin lymphoma and continued high survival for children in the Netherlands: a population-based study during 1990-2015

Ardine M J Reedijk  1 , Eline A M Zijtregtop  1   2 , Jan Willem W Coebergh  3 , Friederike A G Meyer-Wentrup  1   2 , Konnie M Hebeda  4 , C Michel Zwaan  1   2   5 , Geert O R Janssens  1   6 , Rob Pieters  1 , Wouter J Plattel  7 , Avinash G Dinmohamed  8 , Josée M Zijlstra  9 , Leontien C M Kremer  1   10 , Pieternella J Lugtenburg  11 , Auke Beishuizen  1   2 , Henrike E Karim-Kos  3   8
Affiliations
Clinical Trial

Improved survival for adolescents and young adults with Hodgkin lymphoma and continued high survival for children in the Netherlands: a population-based study during 1990-2015

Ardine M J Reedijk et al. Br J Haematol. 2020 Jun.

Abstract

Population-based studies that assess long-term patterns of incidence, major aspects of treatment and survival are virtually lacking for Hodgkin lymphoma (HL) at a younger age. This study assessed the progress made for young patients with HL (<25 years at diagnosis) in the Netherlands during 1990-2015. Patient and tumour characteristics were extracted from the population-based Netherlands Cancer Registry. Time trends in incidence and mortality rates were evaluated with average annual percentage change (AAPC) analyses. Stage at diagnosis, initial treatments and site of treatment were studied in relation to observed overall survival (OS). A total of 2619 patients with HL were diagnosed between 1990 and 2015. Incidence rates increased for 18-24-year-old patients (AAPC + 1%, P = 0·01) only. Treatment regimens changed into less radiotherapy and more 'chemotherapy only', different for age group and stage. Patients aged 15-17 years were increasingly treated at a paediatric oncology centre. The 5-year OS for children was already high in the early 1990s (93%). For patients aged 15-17 and 18-24 years the 5-year OS improved from 84% and 90% in 1990-1994 to 96% and 97% in 2010-2015, respectively. Survival for patients aged 15-17 years was not affected by site of treatment. Our present data demonstrate that significant progress in HL treatment has been made in the Netherlands since 1990.

Keywords: Hodgkin lymphoma; adolescent and young adult; cancer registry; paediatric oncology; population-based.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Age‐specific incidence rates of patients aged <25 years and diagnosed with classical Hodgkin lymphoma in the Netherlands between 1990 and 2015. (A) Incidence rates by age group. (B) Incidence rates by stage. The 3‐year moving averages are shown. The average annual percentage change (AAPC) was calculated for each year of diagnosis with linear regression analyses.
Figure 2
Figure 2
Patients aged <25 years and diagnosed with Hodgkin lymphoma in the Netherlands between 1990 and 2015 and site of treatment. The proportion of patients treated in a University Medical Centre (UMC) by age group is depicted by solid lines. From 2004 onwards, a distinction between UMC and Paediatric Oncology Centre was possible for patients aged <18 years and this is depicted by dashed lines.
Figure 3
Figure 3
Trends in initial treatment modalities for patients aged <25 years and diagnosed with classical Hodgkin lymphoma in the Netherlands over time, 1990–2015, by age group and Ann Arbor Stage. CT, chemotherapy only; CT + RT, chemotherapy plus radiotherapy.
Figure 4
Figure 4
The 5‐ and 10‐year overall survival (OS) for patients aged <25 years and diagnosed with classical Hodgkin lymphoma in the Netherlands by period of diagnosis. (A) 5‐year OS by age group. (B) 10‐year OS by age group. (C) 5‐year OS by stage. (D) 10‐year OS by stage. The P for trend was tested with streg and corrected for follow‐up time. The 10‐year OS for the period 2010–2015 is not applicable.* P < 0.05; ** P < 0.01.
Figure 5
Figure 5
The 5‐year overall survival of classical Hodgkin lymphoma patients aged 15–17 years at diagnosis according to site of treatment. The 5‐year overall survival (OS) for treatment in a paediatric oncology centre was 95% (95% CI 89–98%). The 5‐year OS for treatment outside a paediatric oncology centre was 99% (95% CI 92–100%). P, log rank was 0·16.
Figure 6
Figure 6
Age‐specific mortality rates for deceased Hodgkin lymphoma patients aged <25 years at death and cause of death, in the Netherlands between 1980 and 2016. Th3 3‐year moving averages are shown for three age groups, <15 years at death, 15–19 years at death and 20–24 years at death. The average annual percentage change (AAPC) was calculated for each year of diagnosis with linear regression analyses. AAPC analysis for the age group <15 years was not possible due to many years with zero deaths.
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