الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 136 |  |  |
| | | from | 136 | | |
Abstract
The prognosis of Hodgkin lymphoma and the ability to categorize patients of Hodgkin lymphoma into relevant prognostically different groups had drawn much attention of medical oncology community in the last 3 decades. As the ability to stratifying patients with Hodgkin lymphoma into relevant risk groups will facilities both interpretations the results of clinical trials, and aids in treatment of patients using risk adapted therapy which expected to result in better outcome.
Data regarding prognostic factors in Hodgkin lymphoma is abundant and sometimes confusing .Currently the International Prognostic Score (IPS) is the most extensively used factor to provide prognostic information for advanced Hodgkin lymphoma (stage III,IV), and German Hodgkin Study Group (GHSG) for early Hodgkin lymphoma (stage I,II).
The first aim of the study was to determine the impact of different clinical, pathological and treatment related factors in the survival of patients with Hodgkin lymphoa treated with combination chemotherapy and to identify prognostic factors for outcome.
The second aim of this study was to evaluate the ability of IPS (international prognostic score) and GHSG (German Hodgkin Study Group) in predicting the disease response to treatment, overall survival and relapse free survival rates in Egyptian population.
We retrospectively reviewed the records of 196 patients treated by anthracycline based combination chemotherapy for in the interval between 1996 and 2005.We analyzed clinical parameters : age at presentation , sex , performance status , number of LN groups involvement , presence of B symptoms, presence of mediastinal bulky disease , Ann Arbor stage, level of ( ESR, HB, Albumin ,WBCs, lymphocytes) at presentation. Also analyzed pathological parameters (histological subtype) and treatment received (type of primary chemotherapy received , number of chemotherapy cycles received, usage of salvage chemotherapy in relapsed or refractory patients, number of patients received radiotherapy).
Response to primary combination chemotherapy, disease free and overall survival was analyzed for each parameter and on multivariate analysis.
IPS and GHSG were calculated for patients with completed risk factor data , chi square correlation analysis was used to determine the correlation between response to combination chemotherapy and both IPS and GHSG.
Patients were followed for disease free survival and overall survival with a median of 62 and 120 months respectively. Disease recurrence was developed in 54 patients after median disease free interval of 18 months. At last follow up 34 of the 182 patients had died.
Five-year disease free and overall survival rates on univariate analysis were 67.7and 73.1% for patients with Low IPS risk group, 37.5% and 23.3% for patients with High IPS risk group respectively .
Five-year disease free survival rates on univariate analysis were 67.9and 80.6% for patients with Low risk group GHSG (score 0,1) respectively, 72.7% for patients with High GHSG (>2) risk group.But five-year overall survival rates were 86.7% and 83.2% for patients with Low risk group GHSG (score 0,1) respectively, 81.2% for patients with High GHSG (>2) risk group.
After multivariate analysis independent predictors of short disease free survival were male Sex, older age at presentation, low Albumin level, high WBCs level and low hemoglobin level at presentation.
Multivariate analysis to determine independent predictors of short overall survival was carried out and showed that, older age at presentation, poor performance status, and involvement of two or more LN groups involvment, high WBCs level and lymphcytic count and low Albumin level all had an independent prediction of short overall survival.
This study points out different clinical, pathological and treatment related predictive factors of response to primary combination chemotherapy. Among them age at presentation, performance status, pretreatment (WBCs count, lymphocytic count, HB level, Albumin level and ESR level) number of LN groups involvment, Ann Arbor stage and presence of mediastinal bulky disease can effectively predict disease response.
Again this study points out different clinical, pathological and treatment related prognostic factors of 5-yr DFS, 5-yr OS in patients with Hodgkin lymphoma. Among them, performance status, can effectively predict disease free survival at 5 years. And B symtoms at presention, Ann Arbor stage, albumin level predict overall survival at 5 years.
Finally this study confirms the ability of IPS and GHSG in predicting the response to chemotherapy, DFS and OS in Egyptian patient treated with anthracycline based combination chemotherapy (ABVD) for Hodgkin lymphoma.