Evaluating the risk of lung side effects in older patients with Hodgkin lymphoma

This study investigated whether older patients with Hodgkin lymphoma (HL) were at high risk for developing lung side effects when treated with bleomycin (Blenoxane). The authors found that the odds of developing lung side effects increased significantly with age in these patients.

For patients with HL, age is one of the key factors that determine treatment. Older patients (age 60 and up) are more likely to have an advanced-stage disease, and thus poorer outcomes compared to younger patients. The most commonly used frontline chemotherapy regimen for HL is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine).

However, doxorubicin (Adriamycin) and bleomycin are both associated with serious lung side effects in older patients. These side effects are associated with poorer outcomes. However, how the risk of developing these side effects changes across age groups is unclear.

This study looked at the records of 847 U.S. Veterans with HL. All patients received chemotherapy. Among these, 87.2% (739 patients) received regimens containing bleomycin.

Overall, 9.3% of patients developed lung side effects. On average, patients who developed lung side effects were older, with an average age of 62, and had a history of smoking (76%). The risk of developing lung side effects increased dramatically with age. This risk was 3.24-fold for patients age 60 to 69 and 6.01-fold for patients age 70 or older.

Patients received an average of 3 cycles of bleomycin before developing side effects. Among patients treated with bleomycin, 13% of patients age 60 to 69 developed side effects. Among patients aged 70 or older, this rate was even higher compared to patients age 49 or younger (24% vs. 3%).

This study found that older patients with HL were much more likely to develop lung side effects compared to younger patients. The authors suggest that bleomycin should not be used in older patients, especially those with other health conditions.

This study was retrospective, meaning it looked back in time to analyze data. This study did not include patients outside of the VA, so these results may not apply to all patients. More studies are needed to confirm these results.