Originally published as JCO Early Release 10.1200/JCO.2005.205.60 on October 3 2005

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Role of Hematotoxicity and Sex in Patients With Hodgkin's Lymphoma: An Analysis From the German Hodgkin Study Group

From the First Department of Internal Medicine, Department of Radiation Oncology, Coordination Center for Clinical Trials; and the German Hodgkin Study Group, University Hospital Cologne, Germany

Address reprint requests to A. Engert, MD, First Department of Internal Medicine, Joseph-Stelzmann-Str 9, University Hospital Cologne, 50924 Cologne, Germany; e-mail: a.engert{at}uni-koeln.de

PURPOSE: Several scores have described sex as a prognostic factor in patients with Hodgkin's lymphoma (HL). However, little is known how sex-specific factors influence treatment outcome. We systematically investigated sex differences with regard to pretreatment characteristics and therapy-related variables, and examined their influence on the outcome of HL patients.

PATIENTS AND METHODS: This analysis comprises 4,626 HL patients of all prognostic risk groups who were enrolled onto the multicenter studies HD4 to HD9 of the German Hodgkin Study Group. At 5.5 years, 2,050 female and 2,576 male patients were analyzed.

RESULTS: Male and female patients had similar prognostic factors. There was more acute chemotherapy-related hematotoxicity in women, especially more severe leucopenia (WHO grade 3/4, 69.9% female and 55.2% male; P < .0001). Importantly, this did not translate into more infections. Female patients had similar response rates but fewer relapses and deaths, leading to a significantly better freedom from treatment failure (FFTF; at 66 months, 81% female [95% CI, 79% to 82%] and 74% male [95% CI, 72% to 76%]). Severe leucopenia during chemotherapy was strongly associated with better FFTF, both for males and females. In addition, when only those patients who developed severe leucopenia within the first two cycles of chemotherapy were included, the factor maintained its protective role.

CONCLUSION: The protective role of severe leucopenia suggests the testing of a more individualized therapy. In future trials, this therapy may be tailored in a response-adapted manner depending on the individual toxicity profile within the first cycles.

Supported in part by the German Cancer Aid (Deutsche Krebshilfe), the Competence Network Malignant Lymphoma (Kompetenznetz Maligne Lymphome), and the German Federal Ministry of Science and Education (Bundesministerium für Bildung und Forschung).

Presented in part at American Society of Hematology, Orlando, FL, 2004.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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