First‐line treatment in older patients with Hodgkin lymphoma: a Surveillance, Epidemiology, and End Results (SEER)‐Medicare population‐based study

Abstract

While Hodgkin lymphoma (HL) is highly curable in younger patients, older patients have higher relapse and death rates, which may reflect age-related factors, distinct disease biology and/or treatment decisions. We described the association between patient, disease and geographic factors and first-line treatment in older patients (≥65 years) with incident HL using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1999 to 2014 (n = 2825). First-line treatment initiated at ≤4 months after diagnosis was categorised as: full chemotherapy regimen (n = 699, 24.7%); partial chemotherapy regimen (n = 1016, 36.0%); single chemotherapy agent or radiotherapy (n = 382, 13.5%); and no treatment (n = 728, 25.8%). Among the fully treated, ABVD [doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine]/AVD was most common (n = 635, 90.8%). Adjusted multinomial logistic regression identified factors associated with treatment. Older age, Medicaid dual eligibility, not married, frailty, cardiac comorbidity, prior cancer, earlier diagnosis date, histology, advanced disease Stage, B symptoms and South region were independently associated with increased odds of not receiving full chemotherapy regimens. In conclusion, we found variability in first-line HL treatment for older patients. Treatment

Association of Treatment Intensity With Survival in Older Patients With Hodgkin Lymphoma

“…Exclusion criteria were missing diagnosis month, unknown diagnostic confirmation, diagnosis reported only from autopsy or death certificate, another cancer diagnosis less than 6 months before HL diagnosis, no claims within 6 months of diagnosis, and unknown stage. 12 Patients with only 1 to 10 claims within 6 months of diagnosis were required to have 1 or more HL-related claim.…”

“…Full regimens were based on National Comprehensive Cancer Network guidelines and established chemotherapy regimens used during the study window, with a focus on older patients. 10 , 12 , 15 , 16 , 17 , 18 , 19 Although the number of recommended chemotherapy cycles varied by disease stage, we categorized treatment on the basis of the first 2 cycles, which corresponded to the fewest number of cycles recommended for early stage HL and the fewest number of cycles before response-based treatment adaptation. 10 In addition, using 2 cycles reduces immortal time bias and time-varying confounding (see the Statistical Analysis subsection).…”

“…In addition, older adults, particularly those with comorbidities, may not tolerate multiagent chemotherapy regimens and may be treated with partial chemotherapy regimens or palliative approaches. 4 , 10 , 11 , 12 …”

Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma

“…Patients over age 60 represent 20-30% of new cHL diagnoses annually but remain vastly under-represented in clinical trials, comprising only 5-13% of participants in modern phase III studies [2][3][4][5][6] . These individuals more commonly present with advanced stage, mixed cellularity subtype, as well as varying burdens of age-related medical comorbidities, all of which may impact the fitness for and outcomes with conventional cHL regimens such as ABVD and Stanford V 3,7,8 .…”

A Mechanistic Insight into Doxorubicin Adsorption on N-isopropyl Acrylamide Grafted Nanotube: Optimization Study of Loading Temperature

“…DOX is used to treat various cancers such as gastric, lung, breast, bladder, ovary, thyroid, bone, nerve tissue, muscles, joints, and soft tissue malignancies (3). It is also used to heal Hodgkin's lymphoma and multiple types of leukemia (4). On the contrary, the drawback of the DOX which has an adverse effect, is the fact that it can also damage healthy human cells and prevent their growth as well (5).…”