Efficacy of a Short Course of Chemotherapy with ABVD for Elderly Patients with Hodgkin Lymphoma for All Disease Stages

INTRODUCTION

Treatment of classical Hodgkin's lymphoma (cHL) in the elderly population remains a challenge. Prevalence of co morbidities, increased toxicity to standard treatments, and the lack of inclusion within clinical trials contribute to this phenomena. Results are often inferior compared to young adults, and there is a paucity of evidence regarding valid treatment approaches. Recently, the GATLA HL-05 protocol has reported the results of a PET/CT-adapted strategy after 3 cycles of ABVD, regardless of stage at presentation and without upper age limit for inclusion¹.

METHODS

In order to evaluate the outcome of elderly patients included in this trial, a retrospective analysis was conducted on the HL-05 database. Patients (pts) equal or older than 60 years with a recent diagnosis of cHL and a negative HIV status were considered. Progression-free survival (PFS) was defined as time from treatment to relapse or death from any cause. Overall survival (OS) was defined as time from treatment to death from any cause. The Kaplan-Meier and Log-rank test method were used for survival curves. The Pearson test was applied for comparison of variables within charts. An α level of 0.05 was regarded as significant.

RESULTS

Of a total 377 pts enrolled within HL-05, 43 met inclusion criteria. With a median age of 66 y, 90% had a performance status of 1-2. Nodular sclerosis was the most frequent histological subtype (60% of pts), and 72% of pts were early stage (I-II, non-bulky disease). All pts received initial therapy with 3 cycles of ABVD and underwent evaluation with a PET/CT scan: 81% achieved a negative scan (Deauville scores 1-2). Of the remaining 19% positive scans, 12% were compatible with PR and 7% with PD. No grade III / IV toxicity events or treatment related deaths were reported. Within a follow-up period of 68 months, median PFS and OS have not yet been reached, and PFS was 88% at 36 months.

CONCLUSIONS

With a PET/CT-adapted therapy after 3 cycles of ABVD for 43 pts older than 60 years, 81% of pts reached a negative scan and thus received no further treatment. These pts had an excellent outcome with a PFS of 88% at 3 years. The implementation of a PET/CT-guided strategy, regardless of stage at presentation, achieved excellent outcomes with a well tolerated treatment with reduced exposition to chemo and radiotherapy. Furthermore, in this study it was possible to validate the prognostic significance of achieving an early negative PET/CT within the elderly population.

CITATIONS

1. Pavlovsky A, Fernandez I, Kurgansky N et al. PET/CT adapted therapy after 3 cycles of ABVD to all stages of Hodgkin Lymphoma: GATLA trial HL-05. Oral Presentation. Abstract S108. EHA 2016 - Copenhagen.

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