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Early‐stage Hodgkin lymphoma in the modern era: simulation modelling to delineate long‐term patient outcomes
Author(s) -
Parsons Susan K.,
Kelly Michael J.,
Cohen Joshua T.,
Castellino Sharon M.,
Henderson Tara O.,
Kelly Kara M.,
Keller Frank G.,
Henzer Tobi J.,
Kumar Anita J.,
Johnson Peter,
Meyer Ralph M.,
Radford John,
Raemaekers John,
Hodgson David C.,
Evens Andrew M.
Publication year - 2018
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15255
Subject(s) - medicine , stage (stratigraphy) , positron emission tomography , quality of life (healthcare) , lymphoma , hodgkin lymphoma , oncology , nuclear medicine , pediatrics , paleontology , nursing , biology
Summary We developed a novel simulation model integrating multiple data sets to project long‐term outcomes with contemporary therapy for early‐stage Hodgkin lymphoma ( ESHL ), namely combined modality therapy ( CMT ) versus chemotherapy alone ( CA ) via 18 F‐fluorodeoxyglucose positron emission tomography response‐adaption. The model incorporated 3‐year progression‐free survival ( PFS ), probability of cure with/without relapse, frequency of severe late effects (LEs), and 35‐year probability of LE s. Furthermore, we generated estimates for quality‐adjusted life years ( QALY s) and unadjusted survival (life years, LY ) and used model projections to compare outcomes for CMT versus CA for two index patients. Patient 1: a 25‐year‐old male with favourable ESHL (stage IA ); Patient 2: a 25‐year‐old female with unfavourable ESHL (stage IIB ). Sensitivity analyses assessed the impact of alternative assumptions for LE probabilities. For Patient 1, CMT was superior to CA ( CMT incremental gain = 0·11 QALY s, 0·21 LY s). For Patient 2, CA was superior to CMT ( CA incremental gain = 0·37 QALY s, 0·92 LY s). For Patient 1, the advantage of CMT changed minimally when the proportion of severe LE s was reduced from 20% to 5% (0·15 QALY s, 0·43 LY s), whereas increasing the severity proportion for Patient 2's LE s from 20% to 80% enhanced the advantage of CA (1·1 QALY s, 6·5 LY s). Collectively, this detailed simulation model quantified the long‐term impact that varied host factors and alternative contemporary treatments have in ESHL.