Hodgkin’s Disease in the Elderly

Abstract

47 patients with Hodgkin’s disease presenting after age 60 were analyzed retrospectively for clinical presentation, distribution of disease, and histopathology, and compared to a younger control group. The types of clinical presentation included: local or generalized adenopathy, 50%; ‘B’ symptoms, 25%; ‘unusual manifestations’ and intra-abdominal complications, 13%; and incidentally discovered disease, 12%. In contrast, the younger group presented less often for symptoms (p < 0.01) and more often for adenopathy (p < 0.01). Disease distribution was unique in the elderly compared to the young with a higher incidence of inguinal (p < 0.01), splenic (p < 0.01), and gastrointestinal disease (p < 0.01) and a lower indicence of mediastinal disease (p < 0.01). Histopathology in elderly patients revealed more lymphocyte depletion and less nodular sclerosis than the young patients. 38 of 47 elderly patients were classified as stage III or IV compared to 22/47 in the young. 26 elderly and only 9 young patients had ‘B’ symptoms. Survival was compared for pathologically matched stage IV A and B patients, and the median duration was 5 and 40 months for the elderly and young groups, respectively, (p < 0.001). This difference may be a consequence of differences in therapeutic approaches toward the elderly. Hodgkin’s disease has distinctive clinical and pathologic features which characterize the disease in the elderly and are relevant to diagnostic and therapeutic management.

Atopy—A favourable prognostic factor for survival in Hodgkin's disease

“…Although the effect of age is independent of the other prognostic variables, among 19 in the older age group (.60y) there was a 95% frequency of MC or LD histology and a 63% frequency of Stage IIIB or IVB. These findings were similar to the same age group reported by Lokich et al, (1974) in which 83% of 47 patients had MC or LD histology and 81% had stage III or IV disease. Median survival of 5 months was very poor and may partly have been explained by the palliative treatment given in some cases.…”

Hodgkin’s Disease in the Elderly : A Retrospective Clinicopathologic Study of 61 Patients Aged over 60 Years

“…While on the one hand, several studies have previously been per formed to investigate the disease in the young age group, on the other hand very few reports have focused specifically on elderly patients [2][3][4][5][6].…”

Prognosis and Management Strategies of Lymphatic Neoplasias in the Elderly

“…In sharp contrast to intermediate-and high-grade NHL, however, the cutoff line for differences in outcome may be drawn already at 40 years [4][5][6]13], 50 years [10,14,15] and only in some studies at 60 [8,9,16] or 70 years of age [17,18]. However, at least data from the large data base of the American College of Surgeons and the SEER data bank suggest that several other risk factors such as advanced stage of the disease and unfavorable histology may be found with higher frequency in the elderly population suffering from Hodgkin's disease [3,10].…”

“…The decision to administer such treatment is frequently dictated by the anticipated toxicity of the treatment protocol, the reduced general condition of the patient or the attitudes of physicians and/or patients. In the study of Lokich et al [8], for example, median survival rates in stages I-II, III, and IV were 27, 15, and 3 months, respectively, but two thirds of the patients were treated with only a palliative intent. On the other hand, Wedelin et al [33] report that in their small study cohort of patients aged 150 who were treated with a curative intent, the overall 5-year survival rate was as low as 28%.…”

“…1), as well as variations due to sex, race [3] and histological subtype, since only the mixed cellularity and lymphocyte-depleted subtype were responsible for the second peak in the SEER data base [3]. Nevertheless, age 140 [4][5][6], 150 [7] or 160 [8,9] has been identified as a factor responsible for the adverse prognosis in patients, and unfavorable histologies seem to prevail in advanced age. The fact that 34.1% [10] of patients were over 50 years of age draws attention to the large number of patients in whom age by itself constitutes a risk factor.…”