Treatment patterns and outcomes in adolescents and young adults with nodular lymphocyte‐predominant Hodgkin lymphoma: an IMPACT cohort study

Author:

Punnett Angela12,Baxter Nancy N.34567,Hodgson David2389ORCID,Sutradhar Rinku345,Pole Jason D.4510,Lau Cindy4,Nathan Paul C.1234,Gupta Sumit1234ORCID

Affiliation:

1. Division of Haematology/Oncology The Hospital for Sick Children Toronto Ontario Canada

2. Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada

3. Institute for Health Policy, Evaluation and Management University of Toronto Toronto Ontario Canada

4. Cancer Research Program, ICES Toronto Ontario Canada

5. Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada

6. Department of Surgery and Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada

7. Melbourne School of Population and Global Health University of Melbourne Melbourne Australia

8. Princess Margaret Cancer Centre Toronto Ontario Canada

9. Pediatric Oncology Group of Ontario Toronto Ontario Canada

10. Centre for Health Services Research The University of Queensland Brisbane Australia

Abstract

SummaryWe leveraged population‐based clinical and healthcare data to identify treatment patterns and long‐term outcomes among adolescents and young adults (AYA) with nodular lymphocyte‐predominant Hodgkin lymphoma (NLPHL). All Ontario, Canada, AYA aged 15–21 years at diagnosis with NLPHL between 1992 and 2012 were identified, and their detailed clinical data were collected. Linkage to healthcare databases identified additional events (subsequent malignant neoplasms [SMN], relapses and deaths). Event‐free survival (EFS) and overall survival (OS) were compared by locus of care (adult vs. paediatric) and predictors of outcomes determined. Of 1014 AYA with Hodgkin lymphoma, 54 (5.3%) had NLPHL; 15 (27.8%) were treated at a paediatric centre. No paediatric centre patient received radiation only versus 16 (41.0%) of adult centre patients. Excision only was more common in paediatric centres (p < 0.001). The 20‐year EFS and OS rates were 82.9% ± 5.2% and 100% respectively. Advanced stage (hazard ratio: 4.9, 95% CI: 1.3–18.4; p = 0.02) was associated with inferior EFS. Although the 25‐year cumulative incidence of SMN was 19.3% ± 9.6% for the entire cohort, there were no SMN among the patients treated with excision only. AYA with NLPHL have outstanding long‐term survival. Resection alone was rare outside of paediatric institutions but associated with excellent outcomes. Given substantial SMN risks, chemotherapy‐sparing and radiation‐sparing strategies for appropriate subsets of patients are warranted.

Funder

C17 Children's Cancer and Blood Disorders

Canadian Institutes of Health Research

Pediatric Oncology Group of Ontario

Publisher

Wiley

Subject

Hematology

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