Did the diagnosis and management of Hodgkin lymphoma differ during the SARS-CoV-2 pandemic?

In a recent study published in Current Problems in Cancerresearchers evaluated the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on the diagnosis and treatment of patients with classical Hodgkin lymphoma (cHL) in Istanbul, Turkey.

Studies show that patients with hematological malignancies are usually immunosuppressed, making them highly susceptible to adverse outcomes of coronavirus disease 2019 (COVID-19), including disease severity, hospitalizations, complications, and death. has been reported. Given her increased risk of severe SARS-CoV-2 infection in immunocompromised individuals and the risk of cancer-related morbidity and mortality, the management of patients with hematologic malignancies during the COVID-19 pandemic is It’s getting difficult.

Several hospitals, mostly focused on locking down COVID-19 care, have been introduced during the pandemic. As a result, evaluation of SARS-CoV-2-uninfected individuals was usually postponed. Hospitalizations for illnesses other than COVID-19 have declined due to quarantine and patients fearing SARS-CoV-2 infection. However, delays in cancer diagnosis and management can be fatal.

About research

In the current retrospective and single-center cohort study, investigators measured symptom-to-diagnosis interval (SDI), diagnosis-to-treatment (chemotherapy) interval (DTI), stage of cHL, and chemotherapy response to We compared the responses of diagnosed and diagnosed individuals to chemotherapy. We managed cHL during the pandemic and pre-pandemic period.

Ninety cHL patients diagnosed and managed over a 3-year period at the tertiary center of Cerrahpaşa Medical School were recruited for analysis. The periods from March 2020 to March 2021 and from March 2018 to March 2020 were considered the pandemic and pre-pandemic phases, respectively.

Demographic, clinical, radiological, pathological, and treatment data were obtained for all cHL patients. His two groups of patients were analyzed by demographics, cHL characteristics including histologic subcategories, EBV (Epstein-Barr virus) status, cHL stage at diagnosis, cHL risk score, SDI value, DTI value, The first-line treatment distribution was evaluated comparatively. Intermediate and EOT (end of treatment) responses.

All cHL patients received at least one chemotherapy with bleomycin, brentuximab vedotin (BV), doxorubicin-vinblastine-dacarbazine (AVD), or anthracyclines. His PFTs (pulmonary function tests), such as DCLO (diffusing capacity for carbon monoxide) and spirometry, and positron emission tomography-computed tomography (PET-CT) were performed intermittently and for two treatment cycles. evaluated for each.

Participants were classified into good early-stage, unfavorable early-stage, and advanced-stage groups based on the criteria of the German Hodgkin Study Group. IPS (International Prognostic Score)-3 and 7 were used to stratify patients based on advanced stage cHL prognosis. The Deauville F-PS (5-point scale) was used for initial staging and treatment response assessment.

result

The median age of participants was 34 years and most (53%) were male. A neck mass was the most commonly reported (41%) cHL symptom in the study cohort. Sixty-one percent of the participants had one or more of his B symptoms, and 34% were positive for his EBV. The most common histologic subtypes were tuberous sclerosis HL and mixed-cell cHL, reported in 48% and 37% of participants, respectively.

Early and advanced stage cHL were present in 43% (n=39) and 57% (n=51) of participants, respectively. Extranodal (EN) involvement was identified in 49% of cases (n=44), and the most frequently involved EN sites were the spleen, lung, liver, and bones. , Respectively. Bone marrow was involved in 4% of cases.

Among cHL patients, 72% (n=65) and 28% (n=25) cases received a cHL diagnosis before and during the pandemic, respectively. During the pandemic and pre-pandemic periods, the proportion of individuals with unfavorable cHL among early-stage cHL patients was 78% and 67%, respectively. The proportion of individuals with advanced-stage cHL was higher during the COVID-19 pandemic (64% vs. 54%). However, the difference was not statistically significant.

No significant differences were observed between the two groups of patients with respect to the risk of early-stage cHL, advanced-stage cHL IPS-3 and 7 scores. Median SDI values ​​were significantly higher during the SARS-CoV-2 pandemic than in the pre-pandemic period (16 vs. 8 weeks).

In contrast, median DTI values ​​were comparable between individuals in both study groups (13 vs. 15 days). During the pandemic and pre-pandemic periods, 73% and 85% of cHL patients, respectively, had a CR (complete response) by EOT assessment.

Overall, the findings demonstrate a significant prolongation of SDI during the SARS-CoV-2 pandemic, resulting in a higher proportion of cHL patients presenting with advanced-stage cHL during COVID-19. This is probably due to her SDI lag. However, this difference was not statistically significant for the response to treatment in the two groups.