Hodgkin lymphoma treatment patterns and outcome disparities in low- and middle-income countries

Hodgkin lymphoma (HL) incidence is on the rise globally with higher morbidity and mortality rates in low- and middle-income countries (LMICs). The role of treatment patterns in these disparities is not well understood. We systematically reviewed the published literature on adult HL in LMICs with specific focus on treatment to identify potential gaps in access that may contribute to inequities in outcomes. We searched PubMed, Embase, Scopus, Global Health (EBSCOhost), and Global Index Medicus databases. Two independent reviewers screened articles for inclusion, performed data extraction, and assessed the quality of each study. The review included 111 studies from 34 different LMICs. Most cohorts of HL adults were young, predominantly male, and had advanced stage III/IV HL. Radiation therapy was widely used in only 75 studies (68%) overall. Among first-line studies, 59 (71%) used doxorubicin, bleomycin, vinblastine, and dacarbazine as their primary chemotherapy treatment regimen. Among relapsed/refractory (R/R) HL studies, autologous stem cell transplantation was primarily used in 18 studies (62%). Median 2-year overall survival (OS) was 91% in first-line studies compared with 83% in R/R HL studies. Median 5-year OS in frontline studies was 85% compared with 75% for R/R HL cohorts. There was a positive trend between 2-year OS and gross domestic product per capita. Data on adverse events and treatment-related mortality were underreported. Although we present, to our knowledge, the most comprehensive data on HL treatment options and outcomes in LMICs, our findings are limited by the few studies published in low-income countries and the lack of prospective, high-quality data. Further investigation of HL disparities in LMICs is needed.