Prognostic Factors and Outcomes in Early-Stage Hodgkin Lymphoma in Cape Town
Overview
This retrospective study evaluated progression-free survival (PFS) and overall survival (OS) in early-stage classic Hodgkin lymphoma (cHL) patients treated at Groote Schuur Hospital, Cape Town. Despite resource constraints and high HIV prevalence, outcomes were analyzed in relation to NCCN risk stratification and treatment protocols adapted to local settings.
Background
Classic Hodgkin lymphoma (cHL) primarily affects young individuals with a global incidence of 1–3 per 100,000 annually. People living with HIV have a significantly increased risk of cHL, even with antiretroviral therapy. Early-stage cHL (Lugano stage I and II) typically has a favorable cure rate exceeding 90% with combined chemotherapy and radiotherapy. However, in South Africa, diagnostic delays due to overlapping tuberculosis symptoms result in fewer early-stage diagnoses and poorer survival outcomes compared to high-income countries. Limited data exist on early-stage cHL outcomes and prognostic stratification in this resource-limited, HIV-endemic context.
Data Highlights
Patients with stage I and II cHL diagnosed between 2010 and 2022 at Groote Schuur Hospital were treated with ABVD chemotherapy and risk-adapted radiotherapy per NCCN and ESMO guidelines, modified for local resource constraints. Interim PET/CT after two ABVD cycles guided further treatment. Escalated BEACOPP was not used due to cost and infection risk. Radiotherapy doses varied by risk group, with involved site radiation therapy (ISRT) delivered via 3D conformal or Volumetric Arc Therapy. Response was assessed using International Working Group criteria and Deauville scoring.
Key Findings
Only 13%–18% of cHL patients in South Africa present with early-stage disease, compared to 52%–59% in the United States.
Diagnostic delays due to tuberculosis symptom overlap contribute to advanced disease at presentation and poorer survival.
Early-stage cHL patients at Groote Schuur Hospital were treated with 2–4 cycles of ABVD and ISRT, guided by interim PET/CT and risk stratification.
Escalated BEACOPP was not used due to resource limitations and infection risk concerns.
Interim PET/CT with Deauville score ≥3 defined PET-positive disease prompting treatment intensification or multidisciplinary review.
Outcomes in early-stage cHL in this setting are being evaluated to compare with international benchmarks and inform priorities to reduce healthcare system delays.
Clinical Implications
Early diagnosis and timely treatment initiation remain critical to improving survival in cHL patients in HIV-endemic, resource-limited settings. Adaptation of international treatment guidelines to local constraints, including use of ABVD chemotherapy and risk-adapted radiotherapy, can achieve favorable outcomes. Interim PET/CT is valuable for response assessment and guiding therapy, but access may be limited. Addressing diagnostic delays caused by tuberculosis misdiagnosis is essential to increase early-stage detection rates and improve prognosis.
Conclusion
This study highlights the challenges and outcomes of managing early-stage cHL in a high HIV prevalence, resource-limited setting. Comparable survival outcomes to high-income countries may be achievable if healthcare system delays are addressed and treatment protocols adapted appropriately.
References
International Lymphoma Radiation Oncology Group, NCCN, ESMO Guidelines
