Below the belt.

Top Line: Early stage Hodgkin lymphoma doesn't emerge only above the diaphragm.
The Study: The majority of all early stage Hodgkin lymphomas arise in the mediastinum and cervical lymph nodes. Early stage disease below the diaphragm is treated similarly, but it is unclear if disease in this location is associated with different clinical outcomes. In secondary analysis from the German Hodgkin Study Group (GHSG), data was pooled from the HD13 and HD14 trials. HD13 included patients with favorable disease and found that bleomycin and dacarbazine cannot be safely omitted from ABVD. HD14 included unfavorable patients and found that BEACOPP x 2 + ABVD x 2 improved progression free survival (with more toxicity) compared to ABVD x 4. Only 8% of the combined enrollees had infradiaphragmatic disease, and they were more likely to be older with poor performance statuses and nodular sclerosing histologies. Infradiaphragmatic disease was associated with a 7-10% decrease in progression-free and overall survival. Importantly, the inferior outcomes were overcome in the intensified treatment arms of each study: ABVD x 4 in HD13 and BEACOPP in HD14.
Bottom Line: Patients with infradiaphragmatic, early stage Hodgkin lymphoma have inferior disease and survival outcomes, especially with de-intensified treatment regimens. | Sasse, J Clin Oncol 2018


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