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

Abstract Background Health-related quality of life (HRQoL) was recently demonstrated to improve throughout therapy for high-risk pediatric 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. Methodology 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 (GBTM) 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 three HRQoL groups: Group 1 (consistently unfavorable [25.7%]), Group 2 (moderate-and-increasing [44.8%]), and Group 3 (consistently favorable [29.5%]). Older age (OR[95%CI] 1.24[1.03, 1.50] p = .022), female sex (2.48[1.23, 4.99] p = .011), and Hispanic ethnicity (2.31[0.97, 5.50] p = .059) were associated with increased odds of membership in the Group 1 vs Group 3. Older age (1.18[1.00, 1.39] p = .038) and B-symptoms (2.18[1.09, 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