Incidence and survival of Hodgkin lymphoma patients in Girona (Spain) over three decades: a population-based study

Epstein-Barr Virus in Childhood and Adolescent Classic Hodgkin Lymphoma in a French Cohort of 301 Patients

OBJECTIVE

The aim was to analyze the role of Epstein-Barr virus (EBV) in the bioclinical characteristics of patients treated for classic Hodgkin lymphoma (cHL) in France.

METHODS

Biopathologic data of 301 patients treated for a cHL in/or according to the EuroNet PHL-C1 trial between November 2008 and February 2013 were centrally reviewed.

RESULTS

Median age at diagnosis was 14 (3 to 18) years and the F/M ratio 0.86, 0.47 before 10 years and 0.9 from 11 to 18. CHL subtypes were nodular sclerosis for 266/301 (88%) patients, mixed cellularity for 22/301 (7%), lymphocyte rich for 2/301 (1%), and 11/301 were unclassified. EBV positivity by in situ hybridization was observed for 68/301 (23%) patients, significantly associated with mixed cellularity subtype and male sex, particularly overrepresented in boys below 10 years: 15/23 (65%) versus 28/139 among other male patients (20%). EBV viral load was detectable in 22 of 108 (22%) tested cases and was overrepresented in EBV cHL (13/28) versus non-EBV cHL (9/80) patients. Detailed semiquantitative histologic analysis showed a high number of B-cell residual follicles in EBV cHL relative to EBV-negative HL.

CONCLUSION

Distribution of EBV cHL in children and adolescents is associated with young age and male sex, suggesting a specific physiopathology and may require a differential therapeutic approach.

Primary therapy and relative survival in classical Hodgkin lymphoma: a nationwide population-based study in the Netherlands, 1989-2017

Population-based studies of classical Hodgkin lymphoma (cHL) in contemporary clinical practice are scarce. The aim of this nationwide population-based study is to assess trends in primary therapy and relative survival (RS) during 1989-2017. We included 9,985 patients with cHL. Radiotherapy alone was virtually not applied as from 2000 among patients aged 18-69 years with stage I/II disease, following the broader application of chemotherapy combined with radiotherapy. Chemotherapy only was the preferred treatment for patients with stage III/IV disease. Throughout the entire study period, around 20% of patients aged ≥70 years across all disease stages received no anti-neoplastic therapy. The most considerable improvements in 5-year RS were confined to patients aged 18-59 years. Five-year RS for patients with stage I/II disease diagnosed during 2010-2017 was 99%, 98%, 100%, 93%, 84%, and 61% for patients aged 18-29, 30-39, 40-49, 50-59, 60-69, and ≥70 years, respectively. The corresponding estimates for stage III/IV disease were 96%, 92%, 90%, 80%, 58%, and 46%. Collectively, the improvements in survival likely relate to advances in cHL management. These achievements, however, do not seem to translate into significant benefits for patients ≥60 years. Therefore, novel therapies are urgently needed to reduce excess mortality in elderly cHL patients.

Enigmatic Differences by Sex in Cancer Incidence: Evidence From Childhood Cancers

We investigated the differences in cancer incidence between boys and girls. The incidence data for pediatric cancers were retrieved from the International Incidence of Childhood Cancer project (1990-2015). Poisson regression was applied to detect the sex differences in cancer incidence at global and regional levels. Boys were more susceptible to childhood cancers than girls, with a global boy-to-girl incidence rate ratio of 1.27 (95% confidence interval (CI): 1.26, 1.28) for leukemia, 1.48 (95% CI: 1.46, 1.51) for lymphomas, 1.10 (95% CI: 1.08, 1.11) for central nervous system neoplasms, 1.11 (95% CI: 1.08, 1.13) for neuroblastoma, 1.05 (95% CI: 1.02, 1.09) for retinoblastoma, and 1.39 (95% CI: 1.33, 1.45) for hepatic tumors. Incidence among girls was predominant only in renal tumors (incidence rate ratio = 0.90, 95% CI: 0.88, 0.92). Significant sex differences were observed in childhood cancers based on global-scale cancer data. The most pronounced disparities were observed mostly in developing countries, highlighting that data registration quality should be improved and that attention is needed for health-care access and service utilization for girls in these regions. Additionally, given the limited exposures to environmental risk factors in children, the differences might be mainly attributable to some endogenous risk factors and warrant further investigations.