Comorbidity assessment to determine prognosis in older adult patients with classical Hodgkin lymphoma

Galli, Eugenio; Cuccaro, Annarosa; Maiolo, Elena; Bellesi, Silvia; D’Alo’, Francesco; Fusco, Domenico; Colloca, Giuseppe; Stefano, Valerio De; Hohaus, Stefan

doi:10.1002/hon.2715

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…The major trials included small numbers of elderly patients and there have been few prospective trials for older patients. Frailty, as assessed by formal scores such as the cumulative illness rating score (CIRS) is a strong predictor of OS in elderly HL 61 and the UK Shield registration study 62 has shown that frail patients are consistently unable to complete treatment.…”

Section: Management Of Hodgkin Lymphoma In Elderly Patientsmentioning

confidence: 99%

Guideline for the first‐line management of Classical Hodgkin Lymphoma — A British Society for Haematology guideline

et al. 2022

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This guideline was compiled according to the British Society for Haematology (BSH) process at BSH Guidelines Process 2016 (b-s-h.org.uk). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.grade worki nggro up.org. Recommendations are based on a review of the literature using Medline, PubMed/ Medline and Cochrane searches beginning from 2013 up to January 2021. The following search terms were used: [Hodgkin lymphoma OR Hodgkin disease] NOT non-Hodgkin; AND [chemotherapy OR radiotherapy]; AND [elderly]; AND [teenage OR adolescent OR young adult]; AND [pregnancy]. Filters were applied to include only publications written in English, studies carried out in humans, clinical conferences, congresses, clinical trials, clinical studies, meta-analyses, multicentre studies and randomised controlled trials. References pre-2013 were taken from the previous version of this guideline. 1 Review of the manuscript was performed by the British Society for Haematology (BSH) Guidelines Committee Haematology Oncology Taskforce, the BSH Guidelines Committee and the Haematology Oncology sounding board of BSH.

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Section: Management Of Hodgkin Lymphoma In Elderly Patientsmentioning

confidence: 99%

Guideline for the first‐line management of Classical Hodgkin Lymphoma — A British Society for Haematology guideline

et al. 2022

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“…Unlike in our study, patients aged ≥60 years were included in the study of Galli et al 24 While 54% of the cases in that study had CIRS ≥3, among our cohort, 30.6% of the patients ≥60 years had CIRS >3. In patients aged ≥60 years and receiving upfront ABVD, CR rate in our cohort was higher than that observed in that study (81% vs 92.7%).…”

Section: Discussionmentioning

confidence: 78%

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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“…Comorbid conditions chiefly comprise cardiovascular disease, hypertension, chronic obstructive pulmonary disease, and diabetes. In multivariate analyses of elderly HL patients, comorbidity, but not age (60 or older), was regarded as a significant factor of overall survival, whereas the presence of a comorbidity, stage, and presence of B symptoms were each independently correlated with inferior survival [ 24 ]. The presence of comorbidity as an independent prognostic factor is particularly relevant for older patients.…”

Section: Discussionmentioning

confidence: 99%

An Autopsy Case of an Elderly Patient with Classic Hodgkin Lymphoma Presenting with a Plethora of Clinical Symptoms and Signs

et al. 2020

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Patient: Female, 88-year-old Final Diagnosis: Hodgkin lymphoma Symptoms: Fever • weight loss • dypnea Medication: — Clinical Procedure: — Specialty: Pathology Objective: Unusual clinical course Background: Hodgkin lymphoma (HL) is a potentially curable disease with favorable outcomes. However, elderly patients with HL usually have more adverse prognostic factors and hence a much worse prognosis than younger patients. Case Report: The patient was a woman in her 80s. She reported high fever, anorexia, and a weight loss of 8 kg within 5 months. She had been on treatment for diabetes mellitus and hypertension. She had undergone percutaneous coronary intervention and pacemaker implantation to treat acute coronary syndrome and sinus arrhythmia, respectively. Blood tests showed elevation of alkaline phosphatase, C-reactive protein, leukocyte count, CA 19-9, and carcinoembryonic antigen. Computed tomography did not show tumors in the liver, and cholangitis and sepsis were suspected. Aspartate transaminase, alanine aminotransferase, and total bilirubin gradually increased through the course of the patient’s hospital stay. Despite treatment, her condition deteriorated and she died 22 days after hospital admission. At autopsy, we found stage IV HL with lymph node swelling on both sides of the diaphragm, as well as diffusely disseminated nodules in the liver and spleen. Conclusions: Our patient had several poor prognostic factors including B symptoms, comorbidity, advanced stage, Epstein-Barr virus infection, and expression of programmed death-ligand 1 and interleukin-6, all of which were closely connected with her advanced age. Her age and comorbidities may have been the most adverse prognostic factors for her illness. An effective HL screening method for elderly individuals should be developed to ameliorate poor prognosis and adverse outcomes.

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Comorbidity assessment to determine prognosis in older adult patients with classical Hodgkin lymphoma

Cited by 8 publications

References 29 publications

Guideline for the first‐line management of Classical Hodgkin Lymphoma — A British Society for Haematology guideline

Guideline for the first‐line management of Classical Hodgkin Lymphoma — A British Society for Haematology guideline

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

An Autopsy Case of an Elderly Patient with Classic Hodgkin Lymphoma Presenting with a Plethora of Clinical Symptoms and Signs

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