Treatment Patterns and Outcomes in Early-stage Hodgkin Lymphoma in the Elderly: A National Cancer Database Analysis

Goyal, Gaurav; Maldonado, Edward; Fan, Tiffany J.; Kanmanthareddy, Arun; Silberstein, Peter T.; Go, Ronald S.; Armitage, Jamés O.

doi:10.1016/j.clml.2017.09.009

Cited by 8 publications

(8 citation statements)

References 41 publications

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“…Different performance and comorbidity scales have been used in patients with cHL. 4 , 7 , 16 , 18 In our study and in the study of Sykorova et al, 4 the percentage of patients with a CIRS >3 in patients ≥60 years was 30.6% and 35.7%, respectively. The percentage of cases with ECOG PS 3–4 was significantly higher in patients ≥60 years than in patients 50–59 years, and similarly, in the study of Wrobel et al, 7 rate of patients with ECOG PS 2–4 was higher in patients ≥60 years than that of patients 50–59 years (45% vs 23%, p =0.003).…”

Section: Discussionsupporting

confidence: 61%

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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Section: Discussionsupporting

confidence: 61%

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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“…Moreover, the omission of radiotherapy based on PET‐CT mainly aims at reducing the rate of secondary malignancies, which might not be a priority in older HL patients, as secondary malignancies generally develop up to decades after therapy (Schaapveld et al , ). Importantly, in a recent large National Cancer Database analysis of 3795 older early‐stage HL patients, multivariate analysis, showed that the combination of chemotherapy and radiotherapy resulted in improved OS compared with monotherapy (Goyal et al , ). The OS rate after a median follow‐up of 40·4 months in patients treated with combined modality treatment was 78% compared with 58% and 54% for patients receiving chemotherapy and radiotherapy alone, respectively ( P < 0·0001) (Goyal et al , ).…”

Section: Treatmentmentioning

confidence: 99%

“…Importantly, in a recent large National Cancer Database analysis of 3795 older early‐stage HL patients, multivariate analysis, showed that the combination of chemotherapy and radiotherapy resulted in improved OS compared with monotherapy (Goyal et al , ). The OS rate after a median follow‐up of 40·4 months in patients treated with combined modality treatment was 78% compared with 58% and 54% for patients receiving chemotherapy and radiotherapy alone, respectively ( P < 0·0001) (Goyal et al , ). Therefore, the benefit of radiotherapy as consolidation in elderly patients needs to be balanced against possible toxicity in an individual.…”

Section: Treatmentmentioning

confidence: 99%

The treatment of older Hodgkin lymphoma patients

Böll

Görgen

2018

Br J Haematol

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Summary The outcome of patients with Hodgkin lymphoma (HL) has dramatically improved over the past decades and continues to improve with the development of novel targeted therapies, such as the immunoconjugate brentuximab vedotin and the checkpoint inhibitors nivolumab and pembrolizumab. Moreover, with the use of response‐adapted strategies using positron‐emission‐tomography (PET), the overall intensity of treatment for most patients can be reduced, resulting in less acute and late toxicity. However, these advances are mainly restricted to younger patients, as advances in patients above the age of 60 years (‘older’ patients) have been much less pronounced. Furthermore, about one third of all HL patients are among the older population, but only 5–10% of the patients treated in current HL clinical trials are ≥60 years old. HL in older patients is characterized by aggressive disease and unfavourable prognostic features as B symptoms and predominance of advanced stages. In addition, tolerance to curative chemotherapy is drastically reduced in older patients resulting in excessive toxicity and insufficient treatment due to therapy delays and dose reductions. Therefore, there is a significant unmet medical need in older HL patients for less toxic and effective therapies, and an important gap of knowledge concerning this growing population of patients. Recent advances on epidemiology, characteristics and treatment of older HL patients will be summarized in this article.

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“…More details on the staging system used by the NCDB for Hodgkin lymphoma have been published previously. 11,12…”

Section: Study Populationmentioning

confidence: 99%

Association between facility volume and mortality of patients with classic Hodgkin lymphoma

Goyal

Tella

Funni

et al. 2019

Cancer

Self Cite

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BACKGROUND: Prior studies in oncology have shown that a higher annual facility patient volume is associated with reduced mortality. Because classic Hodgkin lymphoma is uncommon but highly curable, this study used the National Cancer Database (2003Database ( -2014 to analyze whether such a relationship exists for this disease. METHODS: The facilities were classified by quartiles, and random intercepts were used to account for clustering of patients within facilities. A Cox regression model was used to determine the volume-outcome relationship. RESULTS: There were 47,633 patients with classic Hodgkin lymphoma treated at 1310 facilities. The first quartile (Q1), which included 58.4% of the facilities, treated 3 or fewer patients per year, whereas the fourth quartile (Q4), which included 5.9% of the facilities, treated more than 9 patients per year. Compared with the patients treated at Q4 facilities, those treated at lower quartile facilities had a higher risk of death (hazard ratio for the third quartile [HR], 1.19; 95% confidence interval [CI], 1.1-1.29; HR for the second quartile, 1.28; 95% CI, 1.19-1.38; HR for Q1, 1.29; 95% CI, 1.2-1.39) after adjustments for all other factors (P < .0001). Compared with facilities treating 10 patients per year, facilities treating 40 patients per year had approximately 27% lower overall mortality rates. CONCLUSIONS: Patients with classic Hodgkin lymphoma treated at high-volume centers had lower overall mortality than those treated at lower volume centers. Because this is a highly curable malignancy, such differences may suggest a benefit from referral to higher volume facilities or the emulation of their care models. Cancer 2020;126:757-764.

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Treatment Patterns and Outcomes in Early-stage Hodgkin Lymphoma in the Elderly: A National Cancer Database Analysis

Cited by 8 publications

References 41 publications

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

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

The treatment of older Hodgkin lymphoma patients

Association between facility volume and mortality of patients with classic Hodgkin lymphoma

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