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Early-stage Hodgkin lymphoma in the modern era: simulation modelling to delineate long-term patient outcomes

Early-stage Hodgkin lymphoma in the modern era: simulation modelling to delineate long-term patient outcomes
Early-stage Hodgkin lymphoma in the modern era: simulation modelling to delineate long-term patient outcomes

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 LEs. Furthermore, we generated estimates for quality-adjusted life years (QALYs) and unadjusted survival (life years, LY) and used model projections to compare outcomes for CMTversusCA 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 QALYs, 0·21 LYs). For Patient 2, CA was superior to CMT (CA incremental gain = 0·37 QALYs, 0·92 LYs). For Patient 1, the advantage of CMT changed minimally when the proportion of severe LEs was reduced from 20% to 5% (0·15 QALYs, 0·43 LYs), whereas increasing the severity proportion for Patient 2's LEs from 20% to 80% enhanced the advantage of CA (1·1 QALYs, 6·5 LYs). Collectively, this detailed simulation model quantified the long-term impact that varied host factors and alternative contemporary treatments have in ESHL.

Journal Article
0007-1048
212-221
Parsons, Susan K.
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Kelly, Michael J.
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Cohen, Joshua T.
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Castellino, Sharon M.
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Henderson, Tara O.
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Kelly, Kara M.
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Keller, Frank G.
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Henzer, Tobi J.
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Kumar, Anita J.
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Johnson, Peter
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Meyer, Ralph M.
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Radford, John
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Raemaekers, John
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Hodgson, David C.
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Evens, Andrew M.
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Parsons, Susan K.
475db567-2c2b-46bb-bfd1-dee5f5836ca3
Kelly, Michael J.
8f14cfa2-40a1-4afc-b59b-ab580fe9ac75
Cohen, Joshua T.
a9860ccb-0210-4855-b141-79ee5ac8dafb
Castellino, Sharon M.
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Henderson, Tara O.
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Kelly, Kara M.
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Keller, Frank G.
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Henzer, Tobi J.
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Kumar, Anita J.
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Johnson, Peter
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Meyer, Ralph M.
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Radford, John
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Raemaekers, John
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Hodgson, David C.
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Evens, Andrew M.
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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. and Evens, Andrew M. (2018) Early-stage Hodgkin lymphoma in the modern era: simulation modelling to delineate long-term patient outcomes. British Journal of Haematology, 182 (2), 212-221. (doi:10.1111/bjh.15255).

Record type: Article

Abstract

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 LEs. Furthermore, we generated estimates for quality-adjusted life years (QALYs) and unadjusted survival (life years, LY) and used model projections to compare outcomes for CMTversusCA 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 QALYs, 0·21 LYs). For Patient 2, CA was superior to CMT (CA incremental gain = 0·37 QALYs, 0·92 LYs). For Patient 1, the advantage of CMT changed minimally when the proportion of severe LEs was reduced from 20% to 5% (0·15 QALYs, 0·43 LYs), whereas increasing the severity proportion for Patient 2's LEs from 20% to 80% enhanced the advantage of CA (1·1 QALYs, 6·5 LYs). Collectively, this detailed simulation model quantified the long-term impact that varied host factors and alternative contemporary treatments have in ESHL.

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Accepted/In Press date: 5 March 2018
e-pub ahead of print date: 29 April 2018
Published date: July 2018
Keywords: Journal Article

Identifiers

Local EPrints ID: 422019
URI: http://eprints.soton.ac.uk/id/eprint/422019
ISSN: 0007-1048
PURE UUID: 73887bfa-cfaf-4f5d-b9e4-29f0fa4f83e4

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Date deposited: 12 Jul 2018 16:31
Last modified: 15 Mar 2024 20:28

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Contributors

Author: Susan K. Parsons
Author: Michael J. Kelly
Author: Joshua T. Cohen
Author: Sharon M. Castellino
Author: Tara O. Henderson
Author: Kara M. Kelly
Author: Frank G. Keller
Author: Tobi J. Henzer
Author: Anita J. Kumar
Author: Peter Johnson
Author: Ralph M. Meyer
Author: John Radford
Author: John Raemaekers
Author: David C. Hodgson
Author: Andrew M. Evens

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