Group-based trajectories of health-related quality of life among pediatric patients with high-risk Hodgkin lymphoma

Background: Health-related quality of life (HRQoL) was recently demonstrated to improve throughout therapy for high-risk pediatric Hodgkin lymphoma (HL); however, average scores may not reflect individual differences. This study aimed to identify subgroups of patients with similar HRQoL trajectories from pre- to post-therapy. Methods: AHOD1331 trial participants aged 11-20 (n=268; mean [SD] age = 15.6 [1.9]; 48% male) completed the Child Health Ratings Inventories–Global scale (HRQoL) prior to treatment, after cycle 2, after cycle 5, and the end of treatment. Group-based trajectory models (GBTMs) identified latent clusters of individuals with similar HRQoL patterns over time. Multivariable multinomial logistic regression estimated the association between a priori defined characteristics and membership in trajectory-based groups. Log-rank tests examined differences in post-T4 progression-free survival (PFS) by trajectory groups. Results: GBTM identified 3 HRQoL groups: Group 1 (consistently unfavorable [25.7%]), Group 2 (moderate-and-increasing [44.8%]), and Group 3 (consistently favorable [29.5%]). Older age (odds ratio = 1.24, 95% confidence interval = 1.03 to 1.50; P=.022), female sex (2.48, 1.23 to 4.99; P=.011), and Hispanic ethnicity (2.31, 0.97 to 5.50; P=.059) were associated with increased odds of membership in Group 1 vs Group 3. Older age (1.18, 1.00 to 1.39; P=.038) and B-symptoms (2.18, 1.09 to 4.33; P=.027) were associated with increased odds of Group 2 membership vs Group 3. Group membership was not associated with post-T4 PFS. Conclusions: A subgroup of high-risk pediatric HL patients experience persistently poor HRQoL, starting at diagnosis and continuing through therapy. Age, female sex, Hispanic ethnicity, and B-symptoms were linked to worse HRQoL. These findings can help identify patients at higher risk for poor HRQoL and guide intervention. ClinicalTrials.gov NCT02166463.