Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

In recent randomized trials, omitting consolidative radiotherapy in early-stage Hodgkin lymphoma (ESHL) increased relapses. However, decades of follow-up are required to observe whether lower initial disease control is compensated by reduced risk of late effects. Extrapolation beyond trial follow-up is therefore necessary to inform current treatment decisions. To this end, we developed a microsimulation model to estimate lifetime quality-adjusted life years (QALYs) after combined modality treatment (CMT) or chemotherapy-alone for stage I/IIa ESHL. For CMT, the model included risks of breast and lung cancer, coronary heart disease and ischemic stroke. Comparative outcomes were assessed for a clinically relevant range of example patients differing by age, sex, smoking status, and representative organ-at-risk (OAR) radiation doses informed by the RAPID trial. Analysis was performed with and without a 3∙5% discount rate on future health. Smoking status had a large effect on optimal treatment choice. CMT was superior for nearly all never smoker example patients irrespective of age, sex, and OAR doses. At a maximum, CMT produced a 1.095 (95% CI: 1.054 to 1.137) gain in undiscounted QALYs for a 20y male never-smoker with unilateral neck disease. In contrast, current smokers could substantially gain from chemotherapy-alone. Again at a maximum, a 20y male patient with bilateral neck and whole mediastinum involvement gained 3.500 (95% CI: 3.400 to -3.600) undiscounted QALYs with chemotherapy-alone. Overall, CMT was more favorable the younger the patient, when future health discounting was included, and in never-smokers.

Original publication

DOI

10.1182/bloodadvances.2021006254

Type

Journal

Blood Adv

Publication Date

06/12/2021