Treatment Outcome of Refractory/Relapsed High-Grade Non- Hodgkin Lymphoma and Classical Hodgkin Lymphoma at Tikur Anbessa Specialized Hospital: A Retrospective Cross-Sectional Study
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Date
2023-03
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Addis Ababa University
Abstract
Background: High-dose chemotherapy followed by autologous HSCT is the main
stay of treatment for eligible patients with primary refractory or first relapsed high-grade
NHL and classic Hodgkin’s lymphoma (cHL). In centers where this modality of treatment
is not readily available, outcome of salvage chemotherapy alone in this group of patients
is not known. In this single center retrospective study, we evaluated the outcome of
refractory/relapsed high-grade NHL and cHL treated with salvage chemotherapy alone.
Methods: An institution-based cross sectional retrospective study was conducted to
review the outcome of refractory/relapsed lymphomas treated with salvage chemotherapy
from January 2019 to September 2023 at Tikur Anbessa Specialized Hospital (TASH).
Data was collected from HMIS log book and electronic medical records of the patients and
analyzed using SPSS statistical Software. Bivariate and multivariate logistic regression
analysis was performed to identify the predictors of treatment outcome with 95%
confidence interval and p<0.05 being considered as statistically significant. Survival
analysis was performed using Kaplan-Meir method.
Results: A total of 18 cHL (6 refractory and 12 relapsed) and 17 NHL (6 refractory
and 11 relapsed) patients were included in the study. Ten (55.5%) of cHL and 9 (53%) of
NHL patients were males and the median age was 29 and 42 years for the cHL and NHL
groups respectively. The main salvage chemotherapy regimens were DHAP (72%) and
GDP (28%) for cHL while R-DHAP (50%) and R-GDP (17.6%) for NHL. The ORR to
salvage chemotherapy was significantly better for cHL than NHL group, 77.8% and 52.9%
respectively, (p=0.027). The median PFS for cHL and high-grade NHL was 5 and 3
months, and the OS rate was 16 and 7 months, respectively. For both histologic groups,
primary refractory disease, advanced stage at diagnosis and failure to achieve CR after
salvage chemotherapy were associated with trend towards inferior OS. Nausea/vomiting
and hematologic adverse effects were the main treatment related toxicities in both groups.
Conclusion: Three-fourth of patients with RR cHL and half of RR high-grade NHL
respond to salvage chemotherapy alone at our center but the duration of response was not
durable and long-term survival was limited.
Fund: This study was be funded by Addis Ababa university, College of Health Sciences
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Keywords
Lymphoma, Relapse, Refractory, Salvage chemotherapy, Treatment outcome