Advanced stage and unfavorable Hodgkin's disease in the Chinese - a 20-year experience

We retrospectively analyzed 57 patients with advanced stage (stage III/IV) or unfavorable (presence of B symptoms or bulky disease) Hodgkin's disease from January 1977 to December 1997. There were 29 male and 28 female patien ts. The median age was 27 years old (range, 13-59). Lactate dehydrogenase l evels ranged from 104 units/l to 2320 units/l (median, 433). Eighteen (31.6 %), 13 (22.8%), and 26 (45.6%) patients had stage II bulky, stage III, and stage IV disease, respectively. Twenty-five (44%) patients had B symptoms. one (1.8%), 3 (5.3%), 36 (63.2%), and 17 (29.8%) had lymphocyte predominant , lymphocyte depleted, nodular sclerosis, and mixed cellularity histology, respectively. Chemotherapy regimens included mechlorethamine, vincristine, procarbazine, prednisone (MOPP) (n = 9), adriamycin, bleomycin, vinblastine , dacarbazine (ABVD) (n = 23), MOPP alternating with ABVD (n = 13), and COP P-ABV hybrid (n = 12), Complete remission was achieved in 47 (82.4%) patien ts. Eleven patients (23%) relapsed after the first complete remission and f our (36%) attained a second complete remission with salvage chemotherapy. P rojected overall survival was 69.0% at 10 years and 20 years. Disease-free survival rates were 71% at 10 years and 20 years. Of the potential prognost ic factors analyzed (age, sex, stage, lactate dehydrogenase, serum albumin level, regimen, B symptoms and bulky disease) by using the Cox regression m odel, only a low albumin level was found to adversely affect overall surviv al (P = 0.003). In conclusion, despite the relative low incidence of Hodgki n's disease in Hong Kong Chinese, the treatment outcomes in patients with a dvanced stage or unfavorable Hodgkin's disease is comparable to Caucasian p atients. Am. J. Hematol. 61:159-163, 1999. (C) 1999 Wiley-Liss, Inc.