(S054) Long-Term Survival and Racial Differences in Pediatric Hodgkin Lymphoma Patients From the State of Florida: Three Decades of Experience

April 30, 2015

This is the largest retrospective review with the longest outcome to specifically evaluate pediatric Hodgkin lymphoma patients. Furthermore, this is the first analysis to find that AA patients have inferior OS when compared with whites and Hispanics. These differences remained significant over the course of 30 years, indicating that modern treatment modalities have not improved this racial disparity.

Hanmanth Neboori, MD, William Grubb, BS, Hua Li, PhD, MD, Joseph Panoff; University of Miami/Jackson Health System

PURPOSE/METHODS: Hodgkin lymphoma (HL) represents 9% of all pediatric malignancies in the United States. Data are conflicting with regard to racial/ethnic survival differences. We sought to investigate overall survival (OS) differences in a large cohort of racially and ethnically diverse patients with 30 years of follow-up in the state of Florida.

METHODS: The Florida Cancer Database System was used to retrospectively assess the long-term outcomes of 1,778 pediatric patients (age range: 1 mo–21 yr) diagnosed with HL between 1981 and 2010. Log-rank test and Cox univariate and multivariate regression analysis were used to identify predictors of OS.

RESULTS: Median age at diagnosis was 1.7 years (range: 0.1–21 mo). Males and females were equally represented (50.5% vs 49.5%). The database consisted of 68% white, 13% African American (AA), 18% Hispanic, and 2% unknown. The breakdown of diagnosis by decade was as follows: 27% from 1981–1990; 31% from 1991–2000; and 42% from 2000–2010. There were 16% of patients diagnosed as stage I, 42% diagnosed as stage II, 31% diagnosed as stages III and IV, and 11% unknown. Nodular sclerosing was diagnosed in 69% of patients, mixed cellularity was diagnosed in 13%, lymphocyte-rich disease was diagnosed in 4%, lymphocyte-depleted (LD) disease was diagnosed in 2%, and nodular lymphocyte-predominant HL (NLPHL) was diagnosed in 2%. Radiation was administered in 43% of patients, and chemotherapy was given to 73% of patients. Median survival of the entire cohort at the time of last follow-up was 23.8 years. The 5-year OS rate was 84.2%. Men had worse OS than women at 25 years (36% vs 58%; P < .0001). AA patients had worse OS than white and Hispanic patients at 25 years (33% vs 49.2% vs 44.7%, respectively; P = .0005), and this finding persisted after controlling for decade of treatment (P < .001). There was no difference in OS between whites and Hispanics. There were no OS differences regarding decade of treatment, chemotherapy, or age at diagnosis. Patients who had radiation therapy had better OS (hazard ratio [HR] = 1.49; P = .0025). Additionally, patients with the LD subtype had worse OS (HR = 3.85; P = .01).

CONCLUSION: This is the largest retrospective review with the longest outcome to specifically evaluate pediatric Hodgkin lymphoma patients. Furthermore, this is the first analysis to find that AA patients have inferior OS when compared with whites and Hispanics. These differences remained significant over the course of 30 years, indicating that modern treatment modalities have not improved this racial disparity.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org