Current Treatment Options for Older Patients with Hodgkin Lymphoma

Carter, Jordan; David, Kevin A.; Kritharis, Athena; Evens, Andrew M.

doi:10.1007/s11864-020-00745-9

Cited by 9 publications

(14 citation statements)

References 63 publications

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“…By balancing the risk/benefit ratio, bleomycin omission from ABVD (AVD) and integration of BV to AVD have been shown to be reasonable options with favorable outcomes. 7 , 20 As a first-line treatment, ABVD was the most preferred regimen in our patient cohort, similar to other studies. 4 , 5 , 7 , 21 In this study, 6% of the patients aged ≥60 years received AVD, while 4% had AVD + BV, which were compatible with the previous findings as AVD was received in 6.6% 5 and 4% were administered AVD+BV.…”

Section: Discussionsupporting

confidence: 88%

Treatment Responses, Toxicity, and Survival in Patients with Classical Hodgkin Lymphoma Aged ≥50 Years: A Single-Center Experience Over Two Decades

Çokgezer¹,

Elverdi²,

Salihoğlu³

et al. 2022

CMAR

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Introduction The aim of this study was to evaluate treatment responses, toxicity, and survival among cHL patients aged ≥50 years. Methods We retrospectively identified all newly diagnosed cHL patients and only included cases who were ≥50 years old at the time of diagnosis and with data available between 1999 and 2020. Results There were 101 patients, of which 52 were between 50 and 59 years of age, and 49 patients were ≥60 years old. Sixty-two patients were male, and the most common histopathological subtype was mixed cellularity cHL (58.4%). ECOG PS, CCI, CIRS, and ACE-27 scores were significantly higher in patients aged ≥60 years than those of 50–59 age group. While all patients aged 50–59 years received ABVD as first-line therapy, 79% (n=39) of cases aged ≥60 years had ABVD. In patients receiving ABVD, 95% and 92.7% of the cases aged 50–59 and ≥60 years had CR, respectively ( p =0.999). Age groups were comparable in terms of hematological and non-hematological toxicities ( p =0.369, p =0.127, respectively). Although not statistically significant, median survival was longer in patients receiving a transplant than in those without transplantation (108 months vs 52 months, p =0.069). In multivariate analysis, the risk of progression was higher in patients with lymphocyte ≤600/mm 3 and in those who were unresponsive to first-line therapy ( p =0.002 and p <0.001, respectively). Patients with B symptoms, age ≥60 years, and CIRS >3 had higher risk of mortality ( p =0.001, p =0.012, p =0.038, respectively). By using these 3 parameters, we defined a new risk score, which divided our patient cohort into two as low- and high-risk groups. Low-risk patients had significantly higher survival rates than the high-risk group (83.9% vs 40.5%, p <0.001). Discussion This new prognostic score should be further tested and validated in other patient populations. Although our study has some limitations including the limited number of patients and its retrospective nature, there are not so many studies in elderly cHL patients and elderly and/or frail patients are generally excluded in most of the clinical trials. Thus, this real-life single-center experience would contribute to the literature.

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Section: Discussionsupporting

confidence: 88%

Treatment Responses, Toxicity, and Survival in Patients with Classical Hodgkin Lymphoma Aged ≥50 Years: A Single-Center Experience Over Two Decades

Çokgezer¹,

Elverdi²,

Salihoğlu³

et al. 2022

CMAR

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“…The treatment options for HL include chemotherapy and radiation with newer additions, including immunotherapy and targeted therapy based on staging according to NCCN guidelines [ 22 , 23 ]. Elderly patients have a higher degree of adverse events with chemotherapeutic regimens; hence, current studies consider dose attenuation in early-stage disease [ 23 ]. Although HL is a chemo responsive tumor, we can consider debulking surgery in orbital involvement with significant eye symptoms [ 3 , 4 , 11 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Unilateral Ptosis in an Older Adult; a Rare Presentation of Primary Extranodal Hodgkin’s Lymphoma

et al. 2022

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Hodgkin lymphoma (HL) is a neoplasm arising from B cells characterized by the presence of Reed-Steenberg cells. Primary extranodal presentation is rare and accounts for less than 1% of all HL cases. In addition, the orbit is an uncommon site of extranodal HL, with only 9 cases reported in the literature. We present a case of an 84-year-old male who presented with right eye ptosis. He was diagnosed with stage IIE Orbital HL and treated with combined modalities of radiation and chemotherapy. He continues to be in complete remission after 1 year of therapy. Hodgkin’s disease has an excellent prognosis, and recent data show it is curable in at least 80% of the patients. Extranodal involvement represents systemic dissemination of Hodgkin’s disease in most cases and is usually considered an advanced-stage disease with a poor prognosis. In rare circumstances, extranodal involvement can be the primary manifestation. Unfortunately, there are only a few case reports and case series regarding this topic. We attempt to add another case to the literature emphasizing the prognosis and outcome of primary extranodal HL.

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“…Since cHL is frequently occurring in younger adults these long-term adverse effects need to be addressed for further advancing therapy. Treatment of elderly and comorbid patients with r/r cHL remains also challenging with few standard therapies available (Carter et al, 2020). The possibility of inducing on-going CR at low toxicity in comorbid patients highlights the versatility of the MEPED regimen.…”

Section: Discussionmentioning

confidence: 99%

Biomodulatory Treatment Regimen, MEPED, Rescues Relapsed and Refractory Classic Hodgkin’s Disease

et al. 2021

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Introduction: Current combined intensive chemotherapy and radiation regimens yield excellent survival rates in advanced classic Hodgkin’s lymphoma (cHL). However, acute toxicity in elderly, comorbid patients can be challenging and long-term survival in refractory patients remains poor.Patients and Methods: We report on six patients with r/r HL, three patients with long-term follow-up, three newly treated, after biomodulatory therapy. All patients received MEPED (treosulfan 250 mg p.o. daily, everolimus 15 mg p.o. daily to achieve serum trough levels of 15 ng/ml, pioglitazone 45 mg p.o. daily, etoricoxib 60 mg p.o. daily and dexamethasone 0.5 mg p.o. daily). Patients had either received every at that time approved systemic treatment or were ineligible for standard treatment, including immune checkpoint inhibition (ICPi) due to prior demyelinating autoimmune polyneuropathy, myasthenia gravis and previous allogeneic hematopoietic-stem-cell transplant (alloHSCT). Medication was administered continuously from day 1. One patient with relapse after alloHSCT received trofosfamide 50 mg daily instead of treosulfan to avoid risk of increased myelotoxicity. The patients were treated in individual healing attempts outside a clinical trial after institutional review board approval. 18F-fluoro-2-deoxy-d-glucose positron emission tomography combined with computed tomography scan (FDG-PET/CT) was performed to monitor treatment and follow-up.Results: In the three newly treated patients, CT scans showed partial remissions after 2–5 months on MEPED treatment. Two patients had achieved PET Deauville score 2 and 3, while the third remained positive at Deauville score 5. One patient achieving PR became eligible for alloHSCT, while the other two patients continued treatment with MEPED. All patients eventually achieved continuous complete remission (cCR), one after consecutive alloHSCT, one after discontinuing MEPED consolidation for >1 year and one on on-going MEPED consolidation, respectively. Only one patient experienced Grade 3 toxicity (bacterial pneumonia) requiring temporary discontinuation of MEPED for 10 days. All three previously published patients received allo HSCT for consolidation and have achieved cCR.Conclusions: MEPED is well tolerated with low toxicity and highly efficacious in relapsed/refractory cHL, including severely comorbid patients. Due to its immunomodulatory components, MEPED might also have a synergistic potential when combined with ICPi but requires further evaluation within a clinical trial.

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Current Treatment Options for Older Patients with Hodgkin Lymphoma

Cited by 9 publications

References 63 publications

Treatment Responses, Toxicity, and Survival in Patients with Classical Hodgkin Lymphoma Aged ≥50 Years: A Single-Center Experience Over Two Decades

Treatment Responses, Toxicity, and Survival in Patients with Classical Hodgkin Lymphoma Aged ≥50 Years: A Single-Center Experience Over Two Decades

Unilateral Ptosis in an Older Adult; a Rare Presentation of Primary Extranodal Hodgkin’s Lymphoma

Biomodulatory Treatment Regimen, MEPED, Rescues Relapsed and Refractory Classic Hodgkin’s Disease

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