Clinical Outcomes and Patterns of Care Among Patients With Newly Diagnosed Classical Hodgkin Lymphoma in a Safety-Net Health System

Background: There is limited data on outcomes and patterns of care for patients with classical Hodgkin lymphoma (cHL) who are uninsured or have adverse social determinants of health. Methods: We conducted a retrospective cohort study of patients with newly diagnosed cHL treated in a large safety-net hospital system between January 2011 and December 2021. Results: Of the 231 patients aged ≥18 years diagnosed with cHL at Harris Health, Houston, TX, the median age was 39 years, 82% were uninsured, and 87% lived in a neighborhood with an Area Deprivation Index below the national median. Most (73%) had stage III/IV disease; 19% had a history of HIV. The median diagnosis-to-treatment interval was 24 days. The median follow-up interval was 72.3 months. Among 217 evaluable patients, 67% achieved a complete response, and 7% had a partial response. Twenty-two (61%) of 36 eligible patients underwent hematopoietic stem cell transplantation. At 5 years, event-free and overall survival (OS) rates were 62.7% and 79.6%, respectively. Factors associated with OS in multivariable analysis included age (hazard ratio [HR] 1.34 per 10-year increase, P = .007), Eastern Cooperative Oncology Group performance status (HR 2.35 for 2-4 vs. 0-1, P = .026), serum creatinine (HR 2.94 per mg/dL increase, P = .006), and serum albumin (HR 0.59 per g/dL increase, P = .014). Conclusion: In this health system with financial assistance and access to cell therapies, uninsurance was not associated with inferior outcomes. Small survival differences may be due to a greater proportion of patients with advanced-stage, higher-risk, and HIV-associated disease.