Outcome predictors in elderly Hodgkin's lymphoma patients placeholder

Abstract

Background: Despite a profound improvement in the clinical outcome of young HL patients, in the elderly, 5-year survival is estimated at only 40% to 55%. This difference is attributed to the increased rate of comorbidity, treatment toxicity, dose reductions, and lack of standard treatment recommendations in this age group. Under representation of this age group in clinical studies and perhaps different disease biology in the elderly might also contribute to this difference. Methods: All consecutive patients (age ≥ 60), diagnosed with HL between 1998 to 2016 were retrospectively reviewed. Clinical data were recorded and statistical analysis, looking at survival predictors, was performed. Results: Ninety-five patients were identified. Median age at diagnosis was 71 (range, 60-89) years. Sixty-three (69%) patients had advanced disease, mean international prognostic score (IPS) was 3.5 ± 1.4. Forty-four (46%) patients had significant lung or heart disease at diagnosis. Fifty-nine (63%) patients received first line treatment with ABVD and 17 (18%) received BEACOPP-like therapy. Sixty-seven (82%) patients achieved complete remission, 6 (7%) achieved a partial response, 7 (9%) were primary refractory, and 9 (10%) died during induction. Fifteen (21%) patients experienced relapse. At 5 years progression free survival (PFS) and overall survival (OS) were 53.5% and 78% respectively. A significant heart/lung disease was associated with shorter PFS (median PFS 18.9 mo vs not reached at a median follow-up of 5 y, P = .04). Age,, disease status at presentation (early vs advanced, favorable vs unfavorable, and IPS), and treatment regimen had no a statistically significant impact on PFS (5-y PFS = 55% with ABVD vs 50% with BEACOPP-like, :50% with AVD and 33% with MOPP). Nevertheless, 5 year OS in patients receiving ABVD was significantly higher than reported with other therapies (82% with ABVD vs 58% with BEACOPP, P = .04). [Figure]. Restricted analysis, assessing factors that predict the outcome of ABVD treated patients only, found. A higher risk for relapse in patients with a reduced lymphocyte recovery at 12 months post therapy (average lymphocyte count 1250 vs 2057/ml, P < .01). Conclusions: Treatment outcome in our study was comparable or even superior to previously published cohorts. Traditional outcome measures for HL were not predictive according to our results. Nevertheless, cardio-respiratory disease was associated with shorter PFS, and the employment of a non-ABVD regimen was associated with shorter survival. A delayed lymphocyte recovery predicted a higher risk for relapse in ABVD treated patients. Keywords: Hodgkin lymphoma (HL)