Poor outcome in adolescents with high-risk Hodgkin lymphoma

Abstract

This retrospective study looks at the differences between adolescents (15-19 years) and young adults (20-25 years), diagnosed with Hodgkin lymphoma and treated at the same adult institution. Outcome according to risk category was evaluated, and although there were no significant differences in the whole cohort, or low and intermediate-risk categories, high-risk adolescent patients had a significantly worse outcome compared to that of young adults. In these high-risk patients, 5-year event free survival was 43.6% in adolescents compared to 58.7% in young adults (log-rank survival p=0.03), and the 5-year overall survival in adolescents was 66.7% compared to 84.4% in the young adults (p=0.04). Possible contributing factors to this inferior outcome in these high-risk patients were explored. The difference could not be explained in terms of differences in histological subtype (p=0.5), proportion of patients with bulky (p=0.6) or extranodal disease (p=0.6), initial treatment received (chemotherapy alone compared to combination therapy, p=0.2), or proportion proceeding to high-dose treatment after initial treatment failure (p=0.6). There was no difference in the documented number of delays, dose reductions or episodes of non-compliance during initial treatment in the two high-risk age groups. A significantly greater proportion of high-risk adolescents had primary progressive disease (PPD) [eight high-risk adolescents (33.3%) compared to two high-risk young adults, (7.7%), p=0.02].