Hodgkin's disease in the elderly: a population‐based study

Abstract

Summary. This study evaluated the incidence and outcome of Hodgkin's disease (HD) in older patients using a population-based approach. In total, 102 patients (52 men, 50 women) aged ‡ 60 years presented in the Northern Health Region of England (population of 3AE09 million) between 1 January 1991 and 31 December 1998 and were studied prospectively. The age-specific incidence was 1AE97/ 100 000 for those aged 60-69 years, and 2AE18/100 000 for those aged 70 years or over. The median age of the cohort was 70 years (range 60-91) and the median follow up was 63 months (range 20-113). Out of 95 treated patients, 70 (74%) obtained complete or good partial (> 90% response) remissions. In the 60 to 69-year-old group, the disease-specific survival at 5 years was 100% for those presenting with early stage disease and 52% for those with advanced stage disease. In patients aged >70 years the 5 year disease-specific survival was 36% in patients with early stage and 14% for patients with advanced stage disease. The survival of patients with Epstein-Barr virus (EBV)-positive tumours was significantly poorer than that of patients with EBV-negative tumours (P ¼ 0AE007); median survival in the former group was 20 months versus undefined in the latter group. In total, 43 deaths were due to progressive HD and five were treatment-related. This study defined the incidence of HD in our population and demonstrated that the prognosis of elderly patients, particularly those with advanced stage disease, has not improved concurrently with that of patients aged < 60 years old. Novel approaches to assessment and treatment are necessary.

Impact of tumor Epstein-Barr virus status on presenting features and outcome in age-defined subgroups of patients with classic Hodgkin lymphoma: a population-based study

“…Some of the interstudy variation may be attributable to the different epidemiologic features of the disease in different geographic settings and some may be related to case selection. Three previous population-based studies have demonstrated that EBV-associated cases have a poorer prognosis: one was relatively small, 11 and although EBV-positive cases were found to have a poorer outcome than patients with EBV-negative disease, this difference did not reach statistical significance in this small study; one was confined to adults 60 years or older 18 ; and the third was confined to women. 17 In the latter cohort, 17 the adverse effect of EBV association was confined to patients aged 45 to 79 years.…”

“…[1][2][3] The impact of the tumor-cell EBV status on the prognosis of patients with HL remains controversial. Most previous studies have not reported a significant association between EBV status and outcome, [4][5][6][7][8][9][10][11] while others have found that EBV-associated cases have either a more or less favorable prognosis [12][13][14][15][16][17][18] (Table 1). Some of the interstudy variation may be attributable to the different epidemiologic features of the disease in different geographic settings and some may be related to case selection.…”

Senile Epstein-Barr Virus-Associated B-Cell Lymphoproliferative Disorders: a Mini Review

“…Studies by Clarke et al 6 and Stark et al 7 demonstrated that EBV positivity of HRS cells correlated with significantly poorer survival in HL patients aged 45-79 years of age or aged 60 years and over, respectively. Starke et al 7 also determined that EBV status had an adverse effect on clinical outcomes especially in elderly patients (70 years of age and above) compared with that in a younger elderly group (60-69 years of age). Enblad et al 8 also reported that EBV-positive CHL patients were more likely to be older, have increased B symptoms, and more advanced disease.…”

Epstein-Barr Virus-Associated Classical Hodgkin Lymphoma and Its Therapeutic Strategies

“…However, in population-based studies have consistently shown a noticeable survival disadvantage in EBVpositive HL especially in the case of older patients (Enblad et al, 1999;Clarke et al, 2001;Stark et al, 2002), indicating the infl uence of EBV existence in HRS cells on clinical outcome. Furthermore, the fact that an EBV transforming protein, LMP1, is expressed almost 100% in HRS cells of HL in HIV-infected patients suggests that EBV may play as a crucial etiological agent in the generation of HRS cells, at least in certain circumstances (Thompson et al, 2004;Carbone et al, 2009).…”