Background

Approximately 20% of classical Hodgkin’s Lymphoma (cHL) patients are over 60 years of age. There is no standard of care for this age group. Although most patients receive ABVD (Doxorubicin, bleomycin, vinblastine and dacarbazine), a standard regimen in younger patients, little is known regarding the clinical presentation of cHL, and the long term efficacy of ABVD in young and elderly Latin American Mestizo patients.. Defining whether individuals in all age groups and social circumstances benefit from a common treatment approach requires investigation..

Thus we sought to evaluate and compare the clinical presentation and the efficacy of ABVD in the elderly (60 years of age and above) versus the younger population of individuals with cHD.

Methods

We retrospectively analyzed 44 consecutive cHL patients treated with ABVD at the National Cancer Institute in Mexico between 2006 and 2013, as compared to 218 patients under 60 years of age.

Results

Median age for the elderly was 65 (60-89y), without a difference in gender (21m/2 f). According to Ann Arbor staging 6-8-13-14 were stage I, II, III, or IV , respectively. The International Prognostic Score (IPS) was > 3 in all patients. B symptoms were present in 34 patients (77.3%). Mixed cellularity subtype was present in 52.3% of cases and nodular sclerosis subtype (34.1%). The great majority of patients (93%) received at least 1 ABVD (1-6), 27 patients received chemotherapy alone, 14 patients received combined modality treatment and 3 patients only received radiotherapy. Twenty four patients achieved a CR (54.5%), 5 partial responses, 5 had refractory /relapsed disease and 10 couldn’t be evaluated. Unlike younger patients a better response was not demonstrated with combined treatment modality (Table 1). Overall survival for the whole group at 7.2 years was estimated at 75.4% (95% CI 57.1-79.4) The OS (7 y) in elderly group was 75% versus 92% in younger group, however patients with age >75 had a lower survival, 50%. The median follow-up was of 8 years.

Summary

Our study showed no clinical differences between elderly vs younger population and confirms the efficacy of ABVD in elderly patients. The lower OS compared to other series may be related to the advanced stage of disease and poor IPS in our series

Table 1.

Clinical characteristics of elderly versus younger patients

Feature< 60 years (%)>60 years (%)P value
Gender
Male/female 		61.8/38.2 47.5/52.3 0.10 
B Symptoms 77.0 77.3 0.86 
Ann Arbor stage
I
II
III
IV 		7.4
24.9
31.8
35.9 		13.6
18.2
24.5
38.6 		0.45 
IPS >3 48.8 65.9 0.07 
Bulky disease 48.8 38.6 0.26 
Histology
Mixed cellularity
Nodular Sclerosis 		43.8
48.8 		52.3
34.1 		0.60 
Treatment
ABVD
ABVD + RT
RT
Other 		42.4
55.3
2.3
2.3 		61.4
31.8
6.8
4.5 		0.37 
Response
CR
PR
Relapse/progression
NV 		60.8
9.7
18.9
10.6 		54.5
11.4
11.4
22.7 		0.37 
Overall survival (8 years) 92% 75% 0.000 
Feature< 60 years (%)>60 years (%)P value
Gender
Male/female 		61.8/38.2 47.5/52.3 0.10 
B Symptoms 77.0 77.3 0.86 
Ann Arbor stage
I
II
III
IV 		7.4
24.9
31.8
35.9 		13.6
18.2
24.5
38.6 		0.45 
IPS >3 48.8 65.9 0.07 
Bulky disease 48.8 38.6 0.26 
Histology
Mixed cellularity
Nodular Sclerosis 		43.8
48.8 		52.3
34.1 		0.60 
Treatment
ABVD
ABVD + RT
RT
Other 		42.4
55.3
2.3
2.3 		61.4
31.8
6.8
4.5 		0.37 
Response
CR
PR
Relapse/progression
NV 		60.8
9.7
18.9
10.6 		54.5
11.4
11.4
22.7 		0.37 
Overall survival (8 years) 92% 75% 0.000 
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Disclosures

No relevant conflicts of interest to declare.

Topics:
bleomycin/dacarbazine/doxorubicin/vinblastine protocol, lymphoma, older adult, chlorambucil, idiopathic pneumonia syndrome, combined modality therapy, hodgkin disease, mixed cellularity, hodgkin's disease, nodular sclerosis, bleomycin, chemotherapy regimen

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2014 by The American Society of Hematology
2014
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