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Epidemiology

Primary therapy and relative survival in classical Hodgkin lymphoma: a nationwide population-based study in the Netherlands, 1989–2017

Leukemia volume 35, pages 494–505 (2021)Cite this article

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Abstract

Population-based studies of classical Hodgkin lymphoma (cHL) in contemporary clinical practice are scarce. The aim of this nationwide population-based study is to assess trends in primary therapy and relative survival (RS) during 1989–2017. We included 9,985 patients with cHL. Radiotherapy alone was virtually not applied as from 2000 among patients aged 18–69 years with stage I/II disease, following the broader application of chemotherapy combined with radiotherapy. Chemotherapy only was the preferred treatment for patients with stage III/IV disease. Throughout the entire study period, around 20% of patients aged ≥70 years across all disease stages received no anti-neoplastic therapy. The most considerable improvements in 5-year RS were confined to patients aged 18–59 years. Five-year RS for patients with stage I/II disease diagnosed during 2010–2017 was 99%, 98%, 100%, 93%, 84%, and 61% for patients aged 18–29, 30–39, 40–49, 50–59, 60–69, and ≥70 years, respectively. The corresponding estimates for stage III/IV disease were 96%, 92%, 90%, 80%, 58%, and 46%. Collectively, the improvements in survival likely relate to advances in cHL management. These achievements, however, do not seem to translate into significant benefits for patients ≥60 years. Therefore, novel therapies are urgently needed to reduce excess mortality in elderly cHL patients.

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Fig. 1: Age-specific incidence rates of patients with classical Hodgkin lymphoma in the Netherlands according to sex and disease stage, 1989–2017.
Fig. 2: Primary therapy of adult patients with classical Hodgkin lymphoma in the Netherlands according to age at diagnosis and calendar period of diagnosis, 1989–2017.
Fig. 3: Primary therapy of adult patients with classical Hodgkin lymphoma in the Netherlands according to disease stage and age at diagnosis, 2014–2017.
Fig. 4: Relative survival of patients with limited-stage (I/II) and advanced-stage (III/IV) classical Hodgkin lymphoma in the Netherlands according to age at diagnosis and calendar period of diagnosis, 1989–2017.

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Acknowledgements

The authors would like to thank the registration clerks of the Netherlands Cancer Registry (NCR) for their dedicated data collection. The nationwide population-based NCR is maintained and hosted by the Netherlands Comprehensive Cancer Organisation (IKNL). This work was supported by research funding from Stichting SHOW (grant to Julia Driessen).

Author information

Authors and Affiliations

  1. Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam, Amsterdam, The Netherlands

    Julia Driessen, Marie José Kersten & Avinash G. Dinmohamed

  2. Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Otto Visser

  3. Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

    Josée M. Zijlstra & Avinash G. Dinmohamed

  4. Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Pieternella J. Lugtenburg

  5. Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Wouter J. Plattel

  6. Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Avinash G. Dinmohamed

  7. Department of Public Health, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands

    Avinash G. Dinmohamed

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Contributions

AGD designed the study; JD analyzed the data; AGD provided statistical support; OV collected the data; JD wrote the manuscript with contributions from all authors, who also interpreted the data, and read, commented on, and approved the final version of the manuscript.

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Correspondence to Julia Driessen.

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Conflict of interest

There is no financial support for this work that could have influenced the outcomes described in the manuscript. However, particular authors report a potential conflict of interest, which is described below. MJK: Millennium/Takeda: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Roche: Honoraria, Research Funding; Gilead: Honoraria; Kite Pharma: Honoraria; Novartis: Honoraria. PJL: Millennium/Takeda: Consultancy, Research Funding; Servier: Consultancy, Research Funding; Roche: Consultancy; BMS: Consultancy; Sandoz: Consultancy; Genmab: Consultancy. JMZ: Consultant/Advisor: Gilead, Roche, Takeda; Honoraria: Gilead, Roche, Takeda, Janssen. AGD: BMS: Research funding. All remaining authors have declared no competing financial interests.

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Driessen, J., Visser, O., Zijlstra, J.M. et al. Primary therapy and relative survival in classical Hodgkin lymphoma: a nationwide population-based study in the Netherlands, 1989–2017. Leukemia 35, 494–505 (2021). https://doi.org/10.1038/s41375-020-0875-0

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