Raihane Ben Lakhal1, Sondos Hdiji2, Sami Zriba3, Amina Mokrani4, Mohamed Adnen Laatiri5, Yossra BenYoussef6, Faten Ezzaier7, Nabil Toumi8, Salwa Ladeb9, Hanen BenSalah10, Sameh Tebra11, Hatem Frikha12, Taha Messai12, Jamel Daoued10, Noureddine Bouaouina11, Monji Maalej12, Mounir Frikha8, Tarek BenOthmen9, Slim BenAhmed7, Abderrahim Khelif6, Fehmi Msaddek3, Amel Mezlini4, Moez Elloumi2, Balkis Meddeb13. 1. Hôpital Aziza-Othmana, service d'hématologie clinique, Tunis, Tunisie. Electronic address: raihane.benlakhal@gmail.com. 2. Hôpital Hédi-Chaker, service d'hématologie clinique, Sfax, Tunisie. 3. Hôpital Militaire, service d'hématologie clinique, Tunis, Tunisie. 4. Institut Salah-Azaïz, service d'oncologie médicale, Tunis, Tunisie. 5. Hôpital Fattouma-Bourguiba, service d'hématologie clinique, Monastir, Tunisie. 6. Hôpital Farhat-Hached, service d'hématologie clinique, Sousse, Tunisie. 7. Hôpital Farhat-Hached, service d'oncologie médicale, Sousse, Tunisie. 8. Hôpital Habib-Bourguiba, service d'oncologie médicale, Sfax, Tunisie. 9. Centre national de greffe de moelle osseuse, Tunis, Tunisie. 10. Hôpital Habib-Bourguiba, service de radiothérapie carcinologie, Sfax, Tunisie. 11. Hôpital Farhat-Hached, service de radiothérapie carcinologie, Sousse, Tunisie. 12. Institut Salah-Azaïz, service de radiothérapie, Tunis, Tunisie. 13. Hôpital Aziza-Othmana, service d'hématologie clinique, Tunis, Tunisie.
Abstract
OBJECTIVE: In Tunisia, the management of Adult Hodgkin's Lymphoma (HL) has been standardized since 1999. We propose in this study to report the therapeutic results of the national protocol of adult HL treatment (MDH2008). PATIENTS AND METHODS: Our study is prospective multicenter interesting 444 patients followed for HL between July 2008 and June 2013 and treated according to the MDH2008 protocol. The median age of our patients was 30 years. B symptoms were present in 62.8 % of our patients. According to the Ann Arbor classification, our patients were in stages I, II, III and IV in 3 %, 42 %, 26 % and 29 %, respectively. The MDH2008 protocol is based on a strategy adapted to the therapeutic response to 2 cycles of chemotherapy. RESULTS: Response≥75 % to 2 courses of chemotherapy was achieved in 43 % of patients and the response rate at the end of treatment was 92.1 %. Forty-eight patients (11.4 %) had primary failure. In the multi-variant study, bulky mediastinal mass (IMT≥0.35) was an independent predictive factor of primary failure (P: 0.000). Nineteen toxic deaths (4.35 %) were reported. The relapse rate was 7.8 %. Event free survival, relapse-free survival and overall survival at 5years were 75 %, 89 % and 90 %, respectively. Adaptation of the treatment to the 2 cycles response was effective in unfavorable early stages and advanced stages. CONCLUSION: Compared to MDH2002 (second version of Tunisian prospective protocol), the MDH2008 reduced the primary failure rate, the rate of toxic deaths with escalated BEACOPP and the rate of relapse in Tunisian patients.
OBJECTIVE: In Tunisia, the management of Adult Hodgkin's Lymphoma (HL) has been standardized since 1999. We propose in this study to report the therapeutic results of the national protocol of adult HL treatment (MDH2008). PATIENTS AND METHODS: Our study is prospective multicenter interesting 444 patients followed for HL between July 2008 and June 2013 and treated according to the MDH2008 protocol. The median age of our patients was 30 years. B symptoms were present in 62.8 % of our patients. According to the Ann Arbor classification, our patients were in stages I, II, III and IV in 3 %, 42 %, 26 % and 29 %, respectively. The MDH2008 protocol is based on a strategy adapted to the therapeutic response to 2 cycles of chemotherapy. RESULTS: Response≥75 % to 2 courses of chemotherapy was achieved in 43 % of patients and the response rate at the end of treatment was 92.1 %. Forty-eight patients (11.4 %) had primary failure. In the multi-variant study, bulky mediastinal mass (IMT≥0.35) was an independent predictive factor of primary failure (P: 0.000). Nineteen toxic deaths (4.35 %) were reported. The relapse rate was 7.8 %. Event free survival, relapse-free survival and overall survival at 5years were 75 %, 89 % and 90 %, respectively. Adaptation of the treatment to the 2 cycles response was effective in unfavorable early stages and advanced stages. CONCLUSION: Compared to MDH2002 (second version of Tunisian prospective protocol), the MDH2008 reduced the primary failure rate, the rate of toxic deaths with escalated BEACOPP and the rate of relapse in Tunisian patients.