Estimating long-term outcomes in classic Hodgkin lymphoma: a United States population-based oncology simulation model based on overall survival from the ECHELON-1 trial

Figures & data

Figure 1. cHL simulation model.

Figure 2. Modeled treatment pathway for stage III/IV cHL in the United States.

Figure 3. Frontline A + AVD utilization for the treatment of stage III/IV cHL: base case and scenario analyses.

Table 1. Efficacy inputs for treatment of cHL.

Regimen	PFS (%)	PFS (mo)	PFS Parameter	OS (%)	OS (mo)	OS Parameter	PFS Source	OS Source
Frontline treatment
Classic ABVD	74.5	72.0	0.0041	89.4	72.0	0.0016	Ansell 2022 [8]	Ansell 2022 [8]
PET-adapted ABVD	74.0	60.0	0.0050	94.0	60.0	0.0010	Stephens 2019 [15]	Stephens 2019 [15]
A + AVD	82.3	72.0	0.0027	93.9	72.0	0.0009	Ansell 2022 [8]	Ansell 2022 [8]
Salvage treatment
BV monotherapy	62.6	24.0	0.0195	94.2	24.0	0.0025	LaCasce 2018 [30]	LaCasce 2018 [30]
BV regimens	77.0	36.0	0.0073	93.0	36.0	0.0020	LaCasce 2018 [30]	LaCasce 2018 [30]
BV + nivolumab	89.0	6.0	0.0194	94.9	24.0	0.0022	Herrera 2018 [27]	LaCasce 2018 [30]
BV + bendamustine	62.6	24.0	0.0195	94.2	24.0	0.0025	LaCasce 2018 [30]	LaCasce 2018 [30]
Other salvage^a	50.0	33.0	0.0210	50.0	106.0	0.0065	Calculated	Calculated
Auto-SCT
With BV	63.0	24.0	0.0193	86.0	30.0	0.0050	Moskowitz 2015 [31]	Moskowitz 2015 [31]
Without BV	51.0	24.0	0.0281	85.0	30.0	0.0054	Moskowitz 2015 [31]	Moskowitz 2015 [31]
Post-Auto-SCT with BV consolidation
BV regimens	22.0	60.0	0.0252	41.0	60.0	0.0149	Calculated	Calculated
BV	22.0	60.0	0.0252	41.0	60.0	0.0149	Chen 2016 [25]	Chen 2016 [25]
BV + PD-1 inhibitor	89.0	60.0	0.0019	97.0	24.0	0.0013	Assumption	Assumption
PD-1 inhibitor	91.0	36.0	0.0026	93.0	36.0	0.0020	Advani 2021 [22]	Advani 2021 [22]
Other	73.5	24.0	0.0128	94.9	24.0	0.0022	Kersten 2021 [28]	Kersten 2021 [28]
Post-Auto-SCT without BV consolidation
BV regimens	22.0	60.0	0.0252	41.0	60.0	0.0149	Calculated	Calculated
BV	22.0	60.0	0.0252	41.0	60.0	0.0149	Chen 2016 [25]	Chen 2016 [25]
BV + PD-1 inhibitor	89.0	60.0	0.0019	97.0	24.0	0.0013	Assumption	Assumption
PD-1 inhibitor	50.0	13.2	0.0525	89.4	24.0	0.0047	Kuruvilla 2021 [29]	Chen 2019 [26]
Other	78.0	60.0	0.0041	59.0	60.0	0.0088	Santoro 2020 [32]	Santoro 2020 [32]
Auto-SCT ineligible^b
BV regimens	50.0	15.3	0.0454	50.0	28.5	0.0243	Calculated	Calculated
BV + nivolumab	89.0	6.0	0.0194	97.0	24.0	0.0013	Herrera 2018 [27]	Herrera 2018 [27]
BV + bendamustine	62.6	24.0	0.0195	94.2	24.0	0.0025	LaCasce 2018 [30]	LaCasce 2018 [30]
PD-1 inhibitor	50.0	13.2	0.0525	90.6	24.0	0.0041	Kuruvilla 2021 [29]	Chen 2019 [26]
Chemotherapy	41.2	3.8	0.2334	56.5	3.8	0.1502	Casadei 2020 [24]	Casadei 2020 [24]
Allo-SCT
Allo-SCT	82.0	6.0	0.0331	87.0	6.0	0.0232	Armand 2018 [23]	Armand 2018 [23]

Abbreviations: ABVD: doxorubicin: bleomycin: vinblastine: dacarbazine; Allo-SCT: allogenic stem cell transplant; Auto-SCT: autologous stem cell transplant; AVD: doxorubicin: vinblastine: dacarbazine; BV brentuximab vedotin; cHL: classic Hodgkin lymphoma; PD-1: programmed death-1; OS: overall survival; PET: positron emission tomography; PFS: progression-free survival.

^a Other regimens in salvage therapy: weighted average hazard functions of PD-1 inhibitor monotherapy and chemotherapy.

^b Brentuximab vedotin-based regimens in SCT ineligible: weighted average hazard functions of brentuximab vedotin monotherapy, brentuximab vedotin + nivolumab, and brentuximab vedotin + bendamustine.

Figure 4. Patient flow in 2031 for stage III/IV cHL: reference case with 0% A + AVD and base case with 27% A + AVD utilization.

Table 2. No. of 1 L patients with stage III/IV cHL progression-free and deaths, SCTs, and second cancers avoided over 10 years with varying 1 L A + AVD utilization compared with the reference scenario without A + AVD.

1L A + AVD utilization	No. of 1L patients alive and progression free in 2031		No. of patients over 10 years
	Total	Additional, n (% change)^a	Deaths		5+ yrs PFS		SCT		Second cancers
			Total	Avoided, n (% change)^a	Total	Additional, n (% change)^a	Total	Avoided, n (% change)^a	Total	Avoided, n (% change)^a
0% (reference case)	20,200	–	2650	–	25,810	–	3200	–	1418	–
27% (base case)	20,388	188 (0.9)	2290	360 (13.6)	26,420	610 (2.4)	2900	300 (9.4)	1308	110 (7.8)
40%	20,478	278 (1.4)	2120	530 (20.0)	26,720	910 (3.5)	2760	440 (13.8)	1255	163 (11.5)
60%	20,617	417 (2.1)	1850	800 (30.2)	27,080	1270 (4.9)	2590	610 (19.1)	1173	245 (17.3)
80%	20,717	517 (2.6)	1810	840 (31.7)	27,440	1,630 (6.3)	2420	780 (24.4)	1099	319 (22.5)

Abbreviations: 1 L: frontline; A + AVD: brentuximab vedotin in combination with doxorubicin, vinblastine, and dacarbazine; cHL: classic Hodgkin lymphoma; PFS: progression-free survival; SCT: stem cell transplantation.

^aCompared with scenario with no A + AVD utilization (i.e. 1 L A + AVD utilization equal to 0).

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