Predicting Long-Term Effects Among Patients Treated for Early-Stage Hodgkin Lymphoma

Andrew Evens, DO, MBA, MSc, discusses the management and prediction of long-term effects among younger patients treated for early-stage Hodgkin lymphoma at the 2023 Great Debates & Updates in Hematologic Malignancies meeting. He discusses the importance of anticipating long-term effects, analyzing individual patient data, as well as predictive modeling. 

Transcript:

Hi, my name is Dr. Andy Evans at the Rutgers Cancer Institute of New Jersey. I'm very happy to be here at the Great Debates and Updates in Hematologic Malignancies [meeting] in Boston, Massachusetts. I'd like to talk to you about the treatment landscape of early-stage Hodgkin lymphoma, and is there anything else we can learn in this space.

One aspect that's so important because we know the majority, 80% plus of patients are younger, meaning, in their 20s and 30s. We've known for decades that this is a very treatable and curable disease [in] upwards of 90% of patients. But we've also known, and especially over the last couple of decades, [that it is] great [that] there's a high cure rate, [but] what about down the road? 

[There are] a couple of really important things about when I say down the road, because we've all in the field of oncology and specifically Hodgkin lymphoma, heard about late effects. What do I mean by late effects? Sometimes when we hear that, we think of 20 [to] 30 years later, [which is] very important. We need to think about that because if you cure someone who's 25, yeah, [the] hope is they're going to live another 50 [to] 60 years. At least when we look at treatment that was given in the 1980s [and] 1990s, yes, there's a certain amount of late effects, whether it's related to radiation and possible arterial disease or breast cancer, but also chemotherapy.

Chemotherapy, of course, is associated with certain issues down the road, in particular adriamycin-related cardiotoxicity. We tend to underestimate that, to be honest. Once you get over 150 milligrams per meter squared of anthracycline, you start to see late effects increase. 

By the way, remember, how many cycles [are in] the treatment? After a couple of cycles of [doxorubicin, bleomycin, vinblastine, and dacarbazine] (ABVD), you're over 150 milligrams per meter. It really starts to become exponential. You can also see other side effects besides anthracycline-induced cardiotoxicity, maybe even some secondary leukemias, et cetera. So that's important [and] that's based on old treatment. 

Is there a way we can take current treatment and estimate late effects? Yes, we can. Now, how do you do that? Well, you need big data, number 1, and you need individual patient data. You can't just do meta-analyses to do that. You need thousands, if not tens of thousands, of cases. The good news is there is a large group of like-minded experts in the world who have conglomerated together with a consortium called HoLISTIC, [which] is Hodgkin Lymphoma International Study for Individual Care. There's a website: hodgkinconsortium.com. 

We have harmonized massive amounts, almost 20,000 patients, from most seminal clinical trials into a very large master database. [It] took a lot of time to synthesize that data, because we want to build models and analytics to have some objective data on what outcomes are if you treat with A, B, or C and [the] patient has X, Y, Z characteristics. Can I get some objective information to provide to the provider as well as the patient to say, based on my characteristics and my lymphoma, here's what I think will happen at 2 years, at 3 years, at 10 years, and at 30 years?

You're able to do that through modeling. Part of it's predictive modeling, something called multi-state modeling. You can even leverage machine learning and simulation modeling. So we just want more data, [and] more analytics in the field, and you can also layer in quality of life, cost-effectiveness, and many other interesting aspects to the field. We're really excited about all the projects in HoLISTIC. 

We've started with early-stage Hodgkin lymphoma. We are also doing it in the advanced stage. We published in the [Journal of Clinical Oncology] (JCO) last year, the Advanced Stage Hodgkin [International Prognostic Index] (HIPI). Yes, it's called the HIPI. On that, we'll look forward to the early stage. We're even now looking at relapsed/refractory, younger, older, all patient populations. 

Because again, we want to think about everything when we're approaching the patient: the immediate, as well as down the road. So many exciting things to come in Hodgkin lymphoma [treatment and management.]

Source: 

Evens A. Antibody Drug Conjugates – Where and When to Use Them in Hodgkin Lymphoma. Presented at the Great Debates and Updates in Hematologic Malignancies Meeting; August 17-19; Boston, Massachusetts.