Early-stage Hodgkin lymphoma in Cape Town, South Africa: prognostic risk factors at diagnosis and treatment outcomes

Classic Hodgkin Lymphoma (cHL) is a highly curable cancer disproportionately affecting younger patients and those with human immunodeficiency virus (HIV) infection. In under-resourced regions with endemic HIV or tuberculosis, cHL treatment outcomes are poor when compared to high-income settings for numerous disease, patient and health systems related factors. Over 80% of patients present with advanced disease and reducing diagnosis delays is thought to be critical in improving survival. However, because early-stage cHL is relatively uncommon in these setting, data evaluating outcomes in patients with early-stage disease are lacking. This retrospective study examined 70 patients with early-stage cHL. These patients, derived from a consecutive cohort of 387 cHL patients treated between 2010 and 2022, were meticulously staged with the Modified Lugano staging system and positron emission tomography / computed tomography (PET/CT). Progression-free survival (PFS), overall survival (OS), and the applicability of National Comprehensive Cancer Network (NCCN) risk stratification were assessed. The median age at diagnosis was 35 years and most patients had stage II (86%), or unfavourable disease (76%). The 5-year OS for the favourable and unfavourable groups were similar (94% vs. 90%, P = 0.599) as was 5-year PFS (83% vs. 88%, P = 0.984). Five-year OS for the HIV positive patients was 94% and 90% in HIV negative patients (P = 0.684), and PFS was 100% and 82%, respectively (P = 0.86). This study demonstrated survival outcomes in early-stage cHL patients comparable with higher income countries, notwithstanding HIV status or unfavourable NCCN classification. In contrast to the previous study from our centre which showed overall survival rates of 66%, for patients with cHL of all disease stages, highlights the importance of facilitating early diagnosis and treatment in low- and middle-income countries.