How the Epidemiology of Hodgkin Lymphoma Changed in Debrecen, Hungary

Abstract

Introduction. Hodgkin lymphoma shows a well-known geographic pattern. Incidence also varies significantly by age, sex, ethnicity and socioeconomic status. These clinical pathological features of the disease are changing. Patients and methods. 715 Hodgkin lymphoma patients’ clinicopathological and treatment data were assessed in a maximum of ten-year periods. The patients were treated at the University of Debrecen, Department of Hematology from 1980 until the end of 2014. Results. The first period (1980-89) contained 193, the second (1990-99) 199, the third (2000-09) 236 and the fourth (2010-14) 87 Hodgkin lymphoma patients. The mean age of the patients were 39, 34.5, 38 and 36.8 years respectively. The male/female ratio was 1.29, 1.23, 1.03 and 0.97 in order. A unimodal age group pattern can be seen in the first and second periods with an incidence peak between 20 and 29 years of age. Bimodal age group pattern was observed in the third and fourth periods with the first incidence peak between 20 and 29 years of age and the second between 50 and 59 years. The incidence of classical mixed cellularity (cMC) histological subtype is decreasing (38%, 49%, 48% and 26%; p < 0.01) while classical nodular sclerosis (cNS) shows an increasing tendency (21%, 28%, 30% and 50%; p < 0.01). The first peak is predominantly caused by the cNS subtype in the third and fourth period, and the second peak caused by cMC subtype in the third and cNS in the fourth period. The number of advanced stage patients (59%) is beyond the early stage patients (41%) in the last observed period. The 5-year overall survival is increasing (64.2%, 84.6%, 87% and 92%). Discussion. The changing patterns can be explained by the altered nature of the disease, changes in immunological features, environmental factors, socioeconomic status and development of diagnostic and therapy methods.