Hodgkin lymphoma of the elderly patients: a retrospective multicenter analysis from the Polish Lymphoma Research Group*

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.

Hodgkin lymphoma transformation of chronic lymphocytic leukemia—A real life data from the Polish Lymphoma Research Group

“…The median overall survival for patients with HvRS was only 13.3 months, which is comparable with the survival reported by Bockorny et al (1.7 years) and Tsimberidou et al (0.8 years), but much shorter than survival observed by others (3.15‐3.9 years) . OS of our patients was also much shorter than the survival of elderly patients with de novo advanced HL being 81% at 3 years . The underlying disease, ie, either HvRS or progressive CLL/SLL were responsible for the majority of deaths, similarly as in other reports .…”

“…[9][10][11]36,43 OS of our patients was also much shorter than the survival of elderly patients with de novo advanced HL being 81% at 3 years. 45 The underlying disease, ie, either HvRS or progressive CLL/SLL were responsible for the majority of deaths, similarly as in other reports. 9,10 The reasons for poor outcome of HvRS patients are multifactorial.…”

“…Our results are better than the response rate in the study of Bockorny et al (CR 27%; PR 25%) 36 or Tsimebridou et al (CR 20%, PR 40%), 10 however, much lower than the respective response rate in the Italian study (ORR 77.3%, CR 68%) 9 and for de novo Hodgkin lymphoma (eg, 64% of CR in elderly population with advanced stage HL). 45 It was recently postulated 8 that an alkylator-based treatment might be suboptimal against purine analogs-exposed clones. This might be valid in our group since almost 70% of patients who received ABVD had been previously exposed to purine analogs.…”

Management of older Hodgkin lymphoma patients

“…Several analyses have documented the frequent occurrence and prognostic importance of comorbidities in older patients. 15,17,[23][24][25] In a study of 194 HL patients registered between 1993 and 1996, the most frequent comorbidity was cardiovascular disease (18%), followed by chronic obstructive lung disease (13%), diabetes mellitus (10%), and hypertension (3%). 24 Furthermore, patients with a severe comorbidity received systemic chemotherapy less frequently and had significantly inferior overall survival (OS).…”

“…Advanced age within the older HL population has been shown to predict survival, with patients aged .70 years having inferior outcomes/ survival vs those aged 60 to 69 years. 5,12,15,25 It is also important to highlight that the International Prognostic Score is not prognostic for outcome of older HL patients. 5,15,26 In a recent multicenter phase 2 study, older HL patients were treated with 2 initial doses of single-agent brentuximab vedotin (BV), followed by doxorubicin, vinblastine, dacarbazine (AVD) for 6 cycles with subsequent post-chemotherapy consolidative BV.…”