High frequency of primary refractory disease and low progression-free survival rate of Hodgkin's lymphoma: a decade of experience in a Latin American center

Abstract Background: Reports dealing with clinical outcomes of classical Hodgkin's lymphoma in low- to middle-income countries are scarce and response to therapy is poorly documented. This report describes the characteristics and clinical outcomes of patients with classical Hodgkin's lymphoma from a single institution in Latin America. Method: A retrospective study was conducted over ten years of patients with classical Hodgkin's lymphoma treated at a referral center. Progression-free and overall survival rates were estimated by Kaplan-Meier analysis. The univariate Cox regression model was used to estimate associations between important variables and clinical outcomes. Main results: One hundred and twenty-eight patients were analyzed. The mean age was 28.5 years. The five-year progression-free and overall survival were 37.3% and 78.9%, respectively. Of the whole group, 55 (43%) were primary refractory cases. Only 39/83 (47%) patients with advanced disease vs. 34/45 (75.6%) in early stages (p-value = 0.002) achieved complete remission. Those with advanced disease had a five-year overall survival of 68.7% vs. 91.8% for early disease (p-value = 0.132). Thirty-one patients relapsed (24.2%) and 20 (64.5%) received a transplant. The hazard ratio for progression with bone marrow infiltration was 2.628 (p-value = 0.037). For death, an International Prognostic Score ≥4 had a hazard ratio of 3.355 (p-value = 0.050) in univariate analysis. Two-thirds of classical Hodgkin's lymphoma patients diagnosed at advanced stages had a low progression-free survival but an overall survival similar to high-income countries. Conclusion: Patients diagnosed with classical Hodgkin's lymphoma in Northeastern Mexico had a significantly low progression-free survival rate and presented with advanced disease, underscoring the need for earlier diagnosis and improved contemporary therapeutic strategies in these mainly young productive-age Hodgkin's lymphoma patients.

Bendamustine for Relapsed and Refractory Hodgkin Lymphomas: Four Cases and a Review of the Literature.

Aims: The management of relapsed/refractory Hodgkin lymphoma is challenging and new choices are needed. Brentuximab vedotin and bendamustine are two effective drugs in these cases. The aim of this study is to present the response to bendamustine after brentuximab failure. Study Design: Retrospective study evaluating the response to bendamustine in four cases with relapsed or refractory Hodgkin lymphoma. Place and Duration of Study: Cukurova University Faculty of Medicine Department of Oncology, between 2012 and 2014. Methodology: Clinical and metabolic responses to bendamustine in four cases with relapsed refractory Hodgkin lymphoma were evaluated. Informed consent was obtained from the patients. Bendamustine was used in four cases with very refractory Hodgkin lymphoma after Brentuximab failure. The dosage was 120 mg/M2 for two consecutive days in 4 weeks, without growth factor support. Results: Four cases with relapsed or refractory Hodgkin lymphoma were treated with bendamustine after brentuximab vedotin failure. Complete metabolic response was documented in two cases,one case did not respond and only short duration of response was determined in one case. Conclusion: Bendamustine is an effective and cost-effective choice in cases with relapsed/refractory Hodgkin lymphoma after brentuximab vedotin failure. However response is of short duration and definitive treatment must be performed as soon as possible.