Impact of individualized treatment on recovery from fatigue and return to work in survivors of advanced stage Hodgkin Lymphoma: results from the randomized international GHSG HD18 trial


  • J. Ferdinandus
  • H. Müller
  • C. Damaschin
  • A.S. Jacob
  • J. Meissner
  • F. Krasniqi
  • U. Mey
  • D. Schöndube
  • J. Thiemer
  • S. Mathas
  • J. Zijlstra
  • R. Greil
  • M. Feuring-Buske
  • J. Markova
  • J.U. Rüffer
  • C. Kobe
  • H.T. Eich
  • C. Baues
  • M. Fuchs
  • P. Borchmann
  • K. Behringer


  • Annals of Oncology


  • Ann Oncol 35 (3): 276-284


  • BACKGROUND: Persisting cancer-related fatigue impairs health related quality of life (HRQoL) and social re-integration in patients with Hodgkin lymphoma (HL). The GHSG HD18 trial established PET-2 guided treatment de-escalation for advanced-stage HL as new standard. Here, we investigate the impact of treatment de-escalation on long-term HRQoL, time-to-recovery from fatigue (TTR-F) and time-to-return to work (TTR-W). PATIENTS AND METHODS: Patients received EORTC QLQ-C30 and life situation questionnaires at baseline, interim, end-of-treatment, and yearly follow-up. TTR-F was defined as time from end of chemotherapy until the first fatigue score < 30. TTR-W was analyzed in previously working or studying patients and measured from end of treatment until first documented work or education. We compared duration of treatment on TTR-F and TTR-W using Cox proportional hazards regression adjusted for confounding variables. RESULTS: HRQoL questionnaires at baseline were available in 1632 (83.9%) of all randomized patients. Overall, higher baseline fatigue and age were significantly associated with longer TTR-F and TTR-W and male sex with shorter TTR-W. Treatment reduction from eight to four chemotherapy cycles led to a significantly shorter TTR-F (HR 1.41, p=0.008) and descriptively shorter TTR-W (HR 1.24, p=0.084) in PET-2 negative patients. Reduction from six to four cycles led to non-significant but plausible intermediate accelerations. Addition of Rituximab caused significantly slower TTR-F (HR 0.70, p=0.0163) and TTR-W (HR 0.64, p = 0.0017) in PET-2 positive patients. HRQoL at baseline and age were the main determinants of 2y HRQoL. CONCLUSIONS: Individualized first-line treatment in patients with advanced-stage HL considerably shortens TTR-F and TTR-W in PET-2 negative patients. Our results support the use of response-adapted shortened treatment duration for patients with HL.