A real-world study of combined modality therapy for early-stage Hodgkin lymphoma: too little treatment impacts outcome

Karan L. Chohan, Jason R. Young, Scott Lester, Muhamad Alhaj Moustafa, Allison Rosenthal, Han W. Tun, Bradford S. Hoppe, Patrick B. Johnston, Ivana N. Micallef, Thomas M. Habermann, Stephen M. Ansell

Research output: Contribution to journalReview articlepeer-review


Multiple clinical trials have assessed de-escalation strategies from combined modality therapy (CMT) to chemotherapy-alone for the treatment of early-stage classical Hodgkin lymphoma (cHL), confirming similar outcomes. The application of these data to the real-world is limited, however. We conducted a retrospective, multicenter cohort study comparing CMT vs chemotherapy-alone in patients with early-stage cHL (stage IA-IIB) treated between January 2010 and December 2020. Positron emission tomography (PET) scans after chemotherapy cycle 2 (PET2) were independently reviewed by a nuclear radiologist (Deauville score $4, positive; #3, negative). Patient outcomes were compared by using an intention-to-treat analysis. Among 125 patients (CMT, n 5 63; chemotherapy-alone, n 5 62) with a median follow-up of 59.8 months (95% CI, 48.6-71.0), no differences in overall survival were observed (5-year overall survival, CMT 98.0% vs chemotherapy-alone 95.1%; log-rank test, P 5 .38). However, there was reduced progression-free survival (PFS) with chemotherapy-alone among all patients (2-year PFS, CMT 95.1% vs chemotherapy-alone 75.3%; log-rank test, P 5 .005) and in those with bulky (n 5 43; log-rank test, P, .001), unfavorable (n 5 81; log-rank test, P 5 .002), or PET2-positive (n 5 15; log-rank test, P 5 .02) disease. No significant differences in PFS were seen for patients with non-bulky (log-rank test, P 5 .35), favorable (log-rank test, P 5 .62), or PET2-negative (log-rank test, P 5 .19) disease. Based on our real-world experience, CMT seems beneficial for patients with early-stage cHL, especially those with PET2-positive and unfavorable disease. Chemotherapy-alone regimens can lead to comparable outcomes for patients with favorable, non-bulky, or PET2-negative disease. We conclude that although results seen in clinical trials are replicated in certain patient subgroups, other subgroups not fitting trial criteria do poorly when radiotherapy is excluded.

Original languageEnglish (US)
Pages (from-to)4241-4250
Number of pages10
JournalBlood Advances
Issue number14
StatePublished - Jul 26 2022

ASJC Scopus subject areas

  • Hematology


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