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Treatment Patterns and Clinical Outcomes in Patients with Hodgkin Lymphoma from Saudi Arabia, Türkiye, and South Africa: Subgroup Analysis from the International, Multi-center, Retrospective BHOLISTIC Study [Turk J Hematol]
| Turk J Hematol. Ahead of Print: TJH-27576 | DOI: 10.4274/tjh.galenos.2024.2024.0181
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Treatment Patterns and Clinical Outcomes in Patients with Hodgkin Lymphoma from Saudi Arabia, Türkiye, and South Africa: Subgroup Analysis from the International, Multi-center, Retrospective BHOLISTIC StudyDavid Brittain1, Saad Akhtar2, Sylvia Rodrigues3, Moosa Patel4, Dhaya Moodley5, Jaimendra Prithipal Singh6, Lydia M Dreosti7, Zainab Mohamed8, Mubarak Al-mansour9, Mohsen Alzahrani10, M Shahzad Rauf2, Irfan Maghfoor2, Sevgi Kalayoğlu Beşişik11, Can Boğa12, Guray Saydam13, Zhongwen Huang14, Jan 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
4Clinical Hematology Unit, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
5Netcare uMhlanga Medical Centre, Durban, South Africa
6Capital Hematology Hospital, Durban, South Africa
7Department of Medication Oncology, Faculty of Medical Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
8Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
9Department of Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs – Western Region, Jeddah, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
10Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
11Department of Internal Medicine, Division of Hematology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
12Division of Hematology, Department of Internal Medicine, Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Adana, Türkiye
13Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, Türkiye
14Statistics & Quantitative Sciences, Takeda Pharmaceuticals International Co., Cambridge, USA
15Takeda (Pty) Ltd, Johannesburg, South Africa
16Division of Hematology, Department of Internal Medicine, Koç University School of Medicine, Istanbul, 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 relapsed/refractory HL (RRHL) from January 2010–December 2013 were assessed. The primary endpoint was progression-free 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, cisplatin (ESHAP) in Saudi Arabia (78.3%) and dexamethasone, cytarabine, cisplatin (DHAP) 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 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. Additionally, 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.
Corresponding Author: David Brittain
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