Hodgkin disease in patients 60 years of age or older. Histologic and clinical features of advanced-stage disease

Abstract

Background. This article reviews the salient pathologic and clinical features of 171 patients with Stage III‐IV disease who were 60 years of age or older who were treated on four Hodgkin disease (HD) protocols from 1969 to 1988. Methods. Pretherapy sections were reviewed centrally for correlation of the histologic classification with anatomic sites of involvement and survival. Results. The diagnosis of HD was confirmed in 114 (66.7%) patients. Non‐Hodgkin lymphomas (NHL) and a miscellaneous non‐HD group accounted for 52 (30.4%) and 5 (2.9%) of the cases. The overall median survival times of patients with Stage III‐IV HD and NHL who were 60 years of age or older in the four protocols were not significantly different (1.5 versus 1.3 years, respectively; P = 0.28). There also was no significant correlation between the survival of these patients with HD and either the Rye classification, 19 specific histologic parameters, or the British National Lymphoma Investigation grading system for HDNS. In the last protocol, the 5‐year survival rate of patients with HD who were 60 years of age or older was lower than that of patients 40–59 years of age or that of those younger than 40 years of age (31% versus 63% versus 79%, respectively, P < 0.0001). Patients with HD entered into the two most recent protocols showed lower incidences of involvement of cervical and iliac‐inguinal‐femoral lymph nodes and skin‐subcutaneous tissues than the patients with NHL who were mis‐diagnosed as HD. Moreover, patients with Stage III‐IV HD in the most recent protocol who were 60 years of age or older had lower rates of involvement of the cervical and mediastinal‐hilar lymph nodes and a higher rate of involvement of the gastrointestinal tract than younger patients. Conclusions. Patients with Stage III‐IV HD and NHL who are 60 years of age or older differ with respect to the rates of involvement of specific anatomic sites but not in survival when treated with HD protocols. In contrast, patients of different age groups with Stage III‐IV HD disease differ with regard to the rates of involvement of anatomic sites and survival.

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

“…[3][4][5][22][23][24] Levis et al analyzed outcomes of patients 65 years of age or older receiving a registry-recommended protocol of ABVD, MOPP, or ABVD/ MOPP therapy. 4 The 8-year PFS and OS were 41% and 46%, respectively, both significantly inferior compared with patients younger than 65 years; notably, 23% of eHL patients receiving ABVD-based therapy had treatment-related death.…”

“…Histology was nodular sclerosis in 47%, mixed cellularity 31%, not otherwise specified 16%, lymphocyte predominant 5%, and lymphocyte depleted 1%. These data confirm prior studies showing eHL more commonly presents with mixed cellularity subtype, [3][4][5] whereas younger patients more frequently have bulky disease at diagnosis supporting that eHL may be biologically distinct.…”

“…1 Studies in the 1970s to the 1990s established 5-year progression-free survival (PFS) or freedom from treatment failure rates for advanced-stage eHL of 30% to 45% with 5-year overall survival (OS) rates of 40% to 55%. [2][3][4][5][6][7][8] There are limited data examining eHL outcomes in the modern era.…”

Phase 2 study of PVAG (prednisone, vinblastine, doxorubicin, gemcitabine) in elderly patients with early unfavorable or advanced stage Hodgkin lymphoma

“…1,[3][4][5] However, several other factors contribute to the poorer outcome of elderly HL patients, including a biologically more aggressive disease, more advanced stages at presentation, higher rates of EBV infections, and more comorbidities. 1,6,7 Because most trials explicitly exclude patients older than 60 years, prospective data in this patient population are sparse. Therefore, current treatment recommendations are largely based on small nonrandomized trials and retrospective population-based studies.…”

The Unique Characteristics and Management of Patients Over 60 Years of Age with Classic Hodgkin Lymphoma

“…In RCTs, only 5% to 10% of all patients are older than 60 years [5,15,16]. To date, data of population-based studies appear to deliver the most accurate estimates.…”