Discordant PET Findings and a High Relapse Rate Characterize Hispanics With Hodgkin's Lymphoma Treated With ABVD

Sumit Gaur; Alexander Philipovskiy; Umeanaeto Onyedika; Anna M Eiring; Alok K Dwivedi; Attilio Orazi

doi:10.21873/cdp.10017

Discordant PET Findings and a High Relapse Rate Characterize Hispanics With Hodgkin's Lymphoma Treated With ABVD

Cancer Diagn Progn. 2021 Jul 3;1(3):127-133. doi: 10.21873/cdp.10017. eCollection 2021 Jul-Aug.

Authors

Sumit Gaur¹, Alexander Philipovskiy¹, Umeanaeto Onyedika¹, Anna M Eiring², Alok K Dwivedi³, Attilio Orazi⁴

Affiliations

¹ Department of Internal Medicine, Texas Tech University Health ScienceCenter- El Paso, Paul L. Foster School of Medicine, El Paso, TX, U.S.A.
² Center of Emphasis in Cancer, Department of Molecular and Translational Medicine,Texas Tech University Health Science Center, El Paso, TX, U.S.A.
³ Division of Biostatistics and Epidemiology, Department of Molecular andTranslational Medicine, Texas Tech University Health Science Center, El Paso, TX, U.S.A.
⁴ Department of Pathology, Texas Tech University Health Science Center, El Paso, TX, U.S.A.

Abstract

Background: Population-based studies on Hodgkin's lymphoma (HL) have shown reduced survival in Hispanics and non-Hispanic Blacks compared with non-Hispanic Whites. To better understand the factors contributing to this outcome discrepancy, we retrospectively reviewed the charts of patients with HL diagnosed and treated at a single institution located along the Texas-Mexico border.

Patients and methods: We performed a retrospective chart review of all patients with HL treated at our institution over an 8-year period (2011-2018). The International Prognostic Score was calculated for all patients and results of positron-emission tomography (PET) scans (interim and end of treatment) were also recorded. Variables analyzed included tumor-related findings (stage, subtype of HL), treatment history (chemotherapy regimen including number of cycles, dose intensity and radiation treatments) and neutrophil to lymphocyte ratio. Quantitative variables were described using median, interquartile range, minimum and maximum observations. Categorical variables were described using frequency and proportions. Kaplan-Meier curves were used to show relapse-free survival.

Results: A total of 24 patients were treated in the time frame, of whom 23 were Hispanic. All were treated with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) or an ABVD-like regimen. Dose intensity for chemotherapy exceeded 90%. After a median follow-up of 43 months, the relapse rate was 45.8%. Positive and negative predictive values for interim PET (0% and 50%) and end of therapy PET (80% and 58%) were suboptimal to allow for a PET-adapted therapeutic approach.

Conclusion: Hispanics have a high relapse rate following ABVD which is not fully explained by universally accepted prognostic factors. Performance of PET scan in predicting outcomes of HL needs to be further studied and optimized before adopting a PET-adapted treatment paradigm for underserved Hispanic populations.

Keywords: ABVD; Hispanic; Hodgkin’s lymphoma; PET; disparity.