No abstract

We retrospectively analyzed long-term disease outcome of 350 elderly Hodgkin Lymphoma (eHL) patients treated with ABVD/ABVD-like regimen enrolled in the PLRG-R9 study between 2001 and 2013 in Poland. Complete remission was reported for 73% of early (ES) and 61% advanced stage (AS) patients. Nine (10%) ES and 56 (20%) AS patients have died. With the median follow-up of 36 (1-190) months, 3-year EFS and OS was 0.74 (95%CI: 0.63-0.85) and 0.90 (95%CI: 0.82-0.98) for ES; 0.51 (95%CI: 0.44-0.57), and 0.81 (95%CI: 0.75-0.86) for AS patients, respectively. For ES patients, Cox regression revealed ECOG <2 and age >70 as predictive for inferior OS and EFS. For AS patients, the most predictive for OS was the presence of cardiovascular disorders (CVD) (p = .00044), while for EFS four factors were significantly associated with a poor outcome: ECOG< 2, age >70 years, CVD and extranodal disease. In conclusion, CVD significantly impacts outcomes of ABVD-treated advanced eHL patients.

Repairs of cleft lip and simultaneous closure of cleft hard palate with vomer flaps are safe in patients with UCLP, and it makes easy the closure of the soft palate later on and decreases the chance of oronasal fistula.

The purpose of the study was to see the short-term outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). A prospective observational study was carried out in 35 patients with unilateral complete cleft lip and palate who under-went cleft lip and cleft hard palate repair with vomer flaps simultaneously. After 3 months, cleft soft palate was repaired. During 1st and 2nd operations, the gap between cleft alveolus and posterior border of the cleft hard palate was measured. Postoperative complications, requirement of blood transfusion during the operation, and duration of operations were also recorded. Simultaneous repairs of cleft lip and closure of cleft hard palate with vomer flaps are easy to perform and are very effective for the repair of cleft lip and palate in UCLP patients. No blood transfusion was needed. Gaps of alveolar cleft and at the posterior border of hard palate were reduced remarkably, which made the closure of the soft palate easier, decreased operation time, and also decreased the chance of oronasal fistula formation.

Elderly patients with Hodgkin lymphoma (HL) have poor prognosis. The inferior outcome has been attributed to a variety of factors including histologic differences, higher incidence of advanced stages, presence of comorbidities, poor performance status, inability to tolerate chemotherapy at full dose and increased treatment-related toxicity and mortality. ABVD is recommended and widely used for elderly patients (pts) although no prospective studies exist to justify this guideline. Moreover there are only few studies, yet most limited in numbers of pts, evaluating the results of HL treatment in elderly population. Here we present the retrospective analysis of outcome of 414 elderly HL pts treated by PLRG allied centers between 2003-2013. Group consisted of 237 men and 177 women. Their median age was 60,5 (50-93) years with the following age ranges:50-59 years-50%, 60-69 years-27%, ≥ 70 years-23%. Histology subtype showed predominance of nodular sclerosis 56%, followed by mixed cellularity 30%. 168 (41%) pts presented with early stage (I,II Ann Arbor) and 246 (59%) with advanced stage (III, IV Ann Arbor). 384 patients were treated with ABVD or ABVD-like regimen, few with CHOP-like(14), BEACOPP(9), PVAG (5) or with corticosteroids only(2). The median follow-up was 28,7 months. The response rates according to age groups are shown in Table 1. Progression free survival (PFS) and overall survival (OS) for all pts were 21 months and 39,5 months, respectively. Median PFS in group 50-59yrs and group 60-69yrs was similar 21,3 months and 22months respectively but was statistically significantly longer than in pts≥70 years old (16 months) (p<0,05). Median OS in group 50-59, 60-69 and ≥ 70 years old was 50,5 months, 35,2 months, 21,5 months, respectively (p<0.05) . Comorbidities were evidently more common in older patients: 30% in 50-59 yrs old, 65% in 60-69 yrs old, 85% in ≥70 yrs old. However, irrespective of age, patients with high burden of cardiovascular disease showed significantly poorer OS and PFS than those with comorbidities other than cardiovascular (OS 29 months vs 41 months, PFS 9 months vs 21 months, respectively, p <0.05). Univariate analysis with Cox regression model including age ≥60, clinical stage >II, presence of B symptoms, IPS>2, serum albumin level below normal, ECOG>1, male sex, erythrocyte sedimentation rate ESR>10 and white blood cells count above the upper limit showed that age ≥60 (p=0.02), clinical stage >II (p=0.04), B symptoms (p=0.01), IPS>2 (p=0.02) and low serum albumin level (p=0.001) had statistically significant negative impact on OS. Multivariate analysis confirmed the significantly negative impact on OS of age ≥60 (p=0.005), IPS>2 (p=0.004) and low albumin level (p=0.002). Although, in our cohort overall response rate was better than in other studies, the outcome is still worse than in younger patients with HL. Specifically the prognosis of patients older than 60 years is even worse than patients who are 10 years younger. Our data also show that ABVD is not appropriate for very elderly patients (≥ 70 years old) and also for those with cardiovascular comorbidities irrespective of age. To find successful strategy for older and frail patients novel approaches should be tested in future trials. Table 1. Response rate according to age. Age, range 50-59 years old 60-69 years old ≥ 70 years old Ann Arbor stage n I-II 89 III-IV 123 I-II 43 III-IV 69 I-II 36 III-IV 54 CR* 79,8% 61,8% 69,8% 60,9% 52,8% 55,6% PR 18,0% 19,5% 23,3% 21,7% 38,9% 27,8% PD 0,0% 4,9% 0,0% 7,2% 0,0% 9,3% 3NR 2,2% 13,8% 7,0% 10,1% 8,3% 7,4% *CR- complete remission, PR- partial remission, PD- progressive disease, NR- no response. Disclosures No relevant conflicts of interest to declare.