Treatment Patterns and Clinical Outcomes in Patients with Hodgkin Lymphoma from Saudi Arabia, Türkiye, and South Africa: Subgroup Analysis from the International Multicenter Retrospective B-HOLISTIC StudyDavid Brittain1, Saad Akhtar2, Sylvia Rodrigues3, Moosa Patel4, Dhaya Moodley5, Jaimendra Prithipal Singh6, Lydia Dreosti7, Zainab Mohamed8, Mubarak Al-Mansour9, Mohsen Alzahrani10, M. Shahzad Rauf2, Irfan Maghfoor2, Sevgi Kalayoglu Besisik11, Can Boga12, Guray Saydam13, Zhongwen Huang14, Yacob Pinchevsky15, Burhan Ferhanoğlu161Alberts Cellular Therapy, Pretoria East Hospital, Pretoria, South Africa
2Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
3Netcare Alberton Hospital, Johannesburg, South Africa
4University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, Department of Medicine, Clinical Hematology Unit, Johannesburg, South Africa
5Netcare uMhlanga Medical Centre, Durban, South Africa
6Capital Hematology Hospital, Durban, South Africa
7University of Pretoria Faculty of Medical Sciences, Steve Biko Academic Hospital, Department of Medication Oncology, Pretoria, South Africa
8Groote Schuur Hospital and University of Cape Town, Department of Radiation Oncology, Cape Town, South Africa
9King Abdulaziz Medical City, Ministry of National Guard Health Affairs - Western Region, Princess Noorah Oncology Center, Department of Oncology, Jeddah, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
10King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Department of Oncology, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia
11İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
12Başkent University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
13Ege University Medical Faculty Hospital, Department of Internal Diseases, Division of Hematology, İzmir, Türkiye
14Takeda Pharmaceuticals International Co., Statistics and Quantitative Sciences, Cambridge, MA, USA
15Takeda (Pty) Ltd, Johannesburg, South Africa
16Koç University School of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
Objective: B-HOLISTIC was a real-world retrospective study of treatment patterns and clinical outcomes in Hodgkin lymphoma (HL) in regions outside Europe and North America. This subgroup analysis reports findings from Saudi Arabia, Türkiye, and South Africa.
Materials and Methods: Patients aged ≥18 years and diagnosed with stage IIB-IV classical HL receiving frontline chemotherapy (frontline cHL) and/or with relapsed/refractory HL (RRHL) from January 2010 to December 2013 were assessed. The primary endpoint was progressionfree survival (PFS) in patients with RRHL.
Results: Overall, 694 patients (RRHL: n=178; frontline cHL: n=653) were enrolled. Among patients with RRHL, >80% received first salvage chemotherapy. The most common first salvage regimens were etoposide, methylprednisolone, cytarabine, and cisplatin in Saudi Arabia (78.3%) and dexamethasone, cytarabine, and cisplatin in Türkiye (36.1%) and South Africa (40%). Median PFS (95% confidence interval [CI]) in the RRHL group was 5.1 (3.0-15.9), 19.7 (7.5-not reached), and 5.2 (1.1-10.1) months in Saudi Arabia, Türkiye, and South Africa, respectively. The 5-year PFS and overall survival (95% CI) rates in patients with RRHL were 33.2% (21.6-45.2) and 78.2% (65.9-86.5) in Saudi Arabia, 42.5% (29.5-54.9) and 79.4% (67.2-87.5) in Türkiye, and 13.1% (4.2-27.0) and 53% (35.5-67.8) in South Africa, respectively.
Conclusion: This study showed that the clinical outcomes in Türkiye and Saudi Arabia were generally comparable with those of Western countries during the study period, although Saudi Arabia had lower PFS rates. Conversely, the clinical outcomes in South Africa were suboptimal, emphasizing the need for novel therapies and improved progression to stem cell transplantation. These data may serve as a control group for future studies in these countries and inform clinical decision-making.
Keywords: Developing countries, Hematological neoplasms, Hematopoietic stem cell transplantation, Real-world evidence, Resource limitations, Treatment outcome
Suudi Arabistan, Türkiye ve Güney Afrika'daki Hodgkin Lenfoma Hastalarında Tedavi Modelleri ve Klinik Sonuçlar: Uluslararası Çok Merkezli Retrospektif B-HOLISTIC Çalışmasından Alt Grup AnaliziDavid Brittain1, Saad Akhtar2, Sylvia Rodrigues3, Moosa Patel4, Dhaya Moodley5, Jaimendra Prithipal Singh6, Lydia Dreosti7, Zainab Mohamed8, Mubarak Al-Mansour9, Mohsen Alzahrani10, M. Shahzad Rauf2, Irfan Maghfoor2, Sevgi Kalayoglu Besisik11, Can Boga12, Guray Saydam13, Zhongwen Huang14, Yacob Pinchevsky15, Burhan Ferhanoğlu161Alberts Cellular Therapy, Pretoria East Hospital, Pretoria, South Africa
2Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
3Netcare Alberton Hospital, Johannesburg, South Africa
4University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, Department of Medicine, Clinical Hematology Unit, Johannesburg, South Africa
5Netcare uMhlanga Medical Centre, Durban, South Africa
6Capital Hematology Hospital, Durban, South Africa
7University of Pretoria Faculty of Medical Sciences, Steve Biko Academic Hospital, Department of Medication Oncology, Pretoria, South Africa
8Groote Schuur Hospital and University of Cape Town, Department of Radiation Oncology, Cape Town, South Africa
9King Abdulaziz Medical City, Ministry of National Guard Health Affairs - Western Region, Princess Noorah Oncology Center, Department of Oncology, Jeddah, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
10King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Department of Oncology, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia
11İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
12Başkent University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
13Ege University Medical Faculty Hospital, Department of Internal Diseases, Division of Hematology, İzmir, Türkiye
14Takeda Pharmaceuticals International Co., Statistics and Quantitative Sciences, Cambridge, MA, USA
15Takeda (Pty) Ltd, Johannesburg, South Africa
16Koç University School of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
Amaç: B-HOLISTIC, Avrupa ve Kuzey Amerika dışındaki bölgelerde Hodgkin lenfomanın (HL) tedavi modelleri ve klinik sonuçları üzerine gerçek dünyadan retrospektif bir çalışmaydı. Bu alt grup analizinde Suudi Arabistan, Türkiye ve Güney Afrika’dan bulgular bildirilmektedir.
Gereç ve Yöntem: Ocak 2010’dan Aralık 2013’e kadar öncül kemoterapi (öncül cHL) ve/veya nükseden/dirençli HL (RRHL) alan evre IIB-IV klasik HL tanısı alan ≥18 yaşındaki hastalar dahil edildi. Birincil sonlanım noktası, RRHL’li hastalarda progresyonsuz sağkalım (PFS) idi.
Bulgular: Total olarak 694 hasta (RRHL: n=178; öncül cHL: n=653) verileri kaydedildi. RRHL’li hastaların %80’inden fazlası ilk kurtarma kemoterapisini aldı. En sık kullanılan ilk kurtarma rejimleri Suudi Arabistan’da (%78,3) etoposid, metilprednizolon, sitarabin ve sisplatin iken Türkiye’de (%36,1) ve Güney Afrika'da (%40) deksametazon, sitarabin ve sisplatin idi. RRHL grubunda medyan PFS (%95 güven aralığı [GA]) Suudi Arabistan, Türkiye ve Güney Afrika’da sırasıyla 5,1 (3,0-15,9), 19,7 (7,5-tamamlanmadı) ve 5,2 (1,1-10,1) ay idi. RRHL hastalarında 5 yıllık PFS ve genel sağkalım (%95 GA) oranları Suudi Arabistan’da %33,2 (21,6-45,2) ve %78,2 (65,9-86,5), Türkiye’de %42,5 (29,5-54,9) ve %79,4 (67,2-87,5) ve Güney Afrika’da sırasıyla %13,1 (4,2-27,0) ve %53 (35,5-67,8) idi.
Sonuç: Bu çalışma, Suudi Arabistan’da PFS oranlarının daha düşük olmasına rağmen, çalışma döneminde Türkiye ve Suudi Arabistan’daki klinik sonuçların genel olarak Batı ülkeleriyle karşılaştırılabilir olduğunu gösterdi. Tersine, Güney Afrika’daki klinik sonuçlar optimalin altındaydı; bu da yeni tedavilere olan ihtiyacı ve kök hücre naklinde ilerlemenin gerektiğini vurguluyordu. Bu veriler, bu ülkelerde yapılacak gelecekteki çalışmalar için bir kontrol grubu görevi görebilir ve klinik karar verme sürecine bilgi sağlayabilir.
Anahtar Kelimeler: Gelişmekte olan ülkeler, Hematolojik neoplazmlar, Hematopoietik kök hücre nakli, Gerçek dünyada verileri, Sınırlı kaynaklar, Tedavi sonucu
David Brittain, Saad Akhtar, Sylvia Rodrigues, Moosa Patel, Dhaya Moodley, Jaimendra Prithipal Singh, Lydia Dreosti, Zainab Mohamed, Mubarak Al-Mansour, Mohsen Alzahrani, M. Shahzad Rauf, Irfan Maghfoor, Sevgi Kalayoglu Besisik, Can Boga, Guray Saydam, Zhongwen Huang, Yacob Pinchevsky, Burhan Ferhanoğlu. Treatment Patterns and Clinical Outcomes in Patients with Hodgkin Lymphoma from Saudi Arabia, Türkiye, and South Africa: Subgroup Analysis from the International Multicenter Retrospective B-HOLISTIC Study. Turk J Hematol. 2024; 41(4): 211-224
Corresponding Author: David Brittain |
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