Treatment outcomes for Hodgkin's lymphoma patients aged 60 and older: A report from the Brazilian prospective Hodgkin's lymphoma registry

Abstract

Introduction: Despite substantial progress in the treatment of Hodgkin's lymphoma (HL), older patients remain an unmet treatment need. Methods: We have analyzed the clinical features and outcomes of patients registered in the Brazilian Prospective HL Registry with age ≥60 and compared them to younger patients. Results: Among 624 patients diagnosed with classical HL from 2009 to 2014 and treated with ABVD, 63 (10%) patients were 60 years or older. Females comprised 35 patients (56%), and 45 patients (72%) had advanced disease by GHSG criteria. In comparison to patients younger than 60, older patients were more likely to present anemia (46% vs 27%, P = .003), to have a high-risk IPS score (59% vs 33%, P < .0001), and histopathology other than nodular sclerosis (51% vs 20%, P < .0001). Median follow-up was 35.6 months (0.53-94) for all patients. The 3-year PFS in younger and older patients were 75% and 60% (P < .0001), respectively. The 3-year OS in younger and older patients were 92% and 69% (P < .0001), respectively. Older patients were also more likely to have a lower socioeconomic status (SES, 48% vs 28%, P = .003) and a lower educational level (25% vs 3%, P < .0001). A higher mortality rate during ABVD treatment was observed in older patients who had a lower SES, compared to those with a higher SES (33% vs 10%, P = .057). Moreover, the effect of SES on outcomes was particularly pronounced in older patients. The 3-year PFS in younger patients with higher and lower SES were 78% and 68% (P = .008) respectively, while in older patients, it was 80% and 43% P = .004) respectively. Table 1 highlights the strong association of both the level of education and SES with age in Brazilian patients. The educational level might influence directly the patient's capacity to recognize the potential graveness of lymphoma symptoms, as suggested by the longer time to diagnosis in illiterate individuals. Similarly, the level of education might impair the patient's ability to promptly react to complications of treatment. Moreover, the prevalence of comorbidities could differ according to the SES. Conclusions: Older Brazilian patients have advanced disease and non-nodular sclerosis subtype more often than younger patients. Treatment outcomes are inferior in older patients. These findings appear to be strongly associated with the lower educational level and lower SES observed in older patients. SES Lower Higher Keywords: ABVD; Hodgkin lymphoma (HL)