A retrospective multicenter analysis of elderly Hodgkin lymphoma: outcomes and prognostic factors in the modern era

Abstract

We investigated a recent (January 1999 to December 2009) cohort of 95 elderly Hodgkin lymphoma subjects. At diagnosis, median age was 67 years (range, 60-89 years), whereas 61% had significant comorbidity, 26% were unfit, 17% had a geriatric syndrome, and 13% had loss of activities of daily living. Overall response rate to therapy was 85%, whereas incidence of bleomycin lung toxicity was 32% (with associated mortality rate, 25%). With 66-month median follow-up, 2-year and 5-year overall survival were 73% and 58%, respectively (advanced-stage, 63% and 46%, respectively). Most International Prognostic Score factors were not prognostic on univariate analyses, whereas Cox multivariate regression identified 2 risk factors associated with inferior overall survival: (1) age more than 70 years (2.24; 95% CI, 1.16-4.33, P ‫؍‬ .02) and (2) loss of activities of daily living (2.71; 95% CI, 1.07-6.84, P ‫؍‬ .04). Furthermore, a novel survival model based on number of these risk factors (0, 1, or 2) showed differential 2-year OS of 83%, 70%, and 13%, respectively (P < .0001) and 5-year OS of 73%, 51%, and 0%, respectively (P < .0001). (Blood. 2012; 119(3):692-695)

Phase 2 study of frontline brentuximab vedotin monotherapy in Hodgkin lymphoma patients aged 60 years and older

“…No pulmonary AEs $ grade 3 were reported, whereas Evens et al 7 reported a 32% incidence of bleomycin lung toxicity (with an associated mortality rate of 25%) among 95 patients, 70% of whom were treated with ABVD. Stamatoullas et al 33 reported a 27% incidence of bleomycin lung toxicity (20% early; 7% late) among 147 ABVD-treated patients, leading the investigators to propose a reduction or omission of bleomycin from the regimen; 29% of deaths in that study were due to toxicity, including 14% due to pulmonary toxicity.…”

“…Evens et al reported an ORR of 85% in 95 patients, 70% of whom received ABVD, 7 and an ORR of 68% in 44 patients treated with ABVD or Stanford V in approximately equal proportions. 8 Similarly, Stamatoullas et al reported an 84% ORR in 147 older HL patients treated with ABVD.…”

“…33 The median PFS of 10.5 months in the current study is shorter than the observations of ;3 years reported in the Evens studies. 7,8 The Evens et al and Stamatoullas et al reports 7,8,33 represent the limited data available describing outcomes in elderly HL patients following standard frontline combination therapy. However, the median ages of the patients in those reports were 65 to 68 years vs 78 years in the current study.…”

“…[3][4][5] Outcomes among older patients with HL tend to be inferior to those of younger patients treated with standard chemotherapy regimens. [5][6][7][8] The biology of HL in older patients may differ from that in younger patients, as manifested by more frequent mixed cellularity histology and Epstein-Barr virus positivity, which is associated with increased HL-specific mortality. 9 Additionally, the presence of comorbidities, particularly cardiac dysfunction, may limit the administration of standard intensity anthracycline-containing regimens.…”

Therapy-Related Late Adverse Events in Hodgkin’s Lymphoma

“…Corticosteroids are the usual treatment, with some evidence of improvement [19]. In a recent retrospective multicenter analysis of the elderly HL by Evens et al [20], an incidence of bleomycin lung toxicity (BLT) of 32% was observed, with an associated mortality rate of 25%; these data supported the association of BLT and risk factors such as older age, cumulative bleomycin dose, renal insufficiency, pulmonary radiation, underlying lung disease, and tobacco history, and the concomitant use of G-CSF (the incidence of BLT was 38% and 0% among pts receiving G-CSF versus patients who did not receive it, resp.) [21].…”