Initial treatment of Hodgkin lymphoma in older patients

This study reviewed treatment options for older patients newly diagnosed with classical Hodgkin lymphoma (cHL). It found that treatments including brentuximab vedotin (BV: Adcetris) are effective in this age group and that avoiding bleomycin (Blenoxane) prevents lung damage.

Around 20% of patients diagnosed with cHL are over 60 years old. Older patients are more likely to have advanced cancer and to have other health issues. Also, patients over 60 are less likely to have a full dose of chemotherapy, due to frailty and side effects.

A common chemotherapy treatment for cHL, bleomycin, causes lung disease in up to a third of older patients. Since it was approved in 2011, some older patients have been treated with the targeted therapy BV. BV is often used along with chemotherapy medications.

Until recently, patients over 60 were not included in most studies of cHL. It is not clear what the best treatment for these patients is.

This article reviewed 15 studies. Overall, 981 newly diagnosed patients with cHL over age 60 were included. Among the studies which assessed frailty, approximately half the patients had other notable health conditions.

688 patients were in 9 studies of chemotherapy. 41% of these patients had advanced disease (stages 3-4). A variety of chemotherapy regimens were used. These included ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), Stanford V (mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone), and BACOPP (bleomycin, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone).

Between 81-91% of patients with early-stage disease survived at least 5 years. Among studies with mostly advanced disease, between 67% and 73% survived at least 3 years.

293 patients were in 6 studies of regimens including BV. Most patients (87.5%) had advanced disease. After treatment, the cancer was no longer detectable in 62% to 90% of patients. After one to two years, between 47% and 84% of patients had not had their cancer progress (worsen).

34-68% of patients treated with chemotherapy had serious side effects (grade 3-5 events). 4 cycles of chemotherapy resulted in more side effects than 2 cycles. Most patients with lung-related side effects had at least two cycles of a regimen containing bleomycin.

64% of patients treated with regimens including BV had serious side effects. 33-78% of patients had loss of nerve function as a side effect.

This study found that both chemotherapy and treatments including BV are effective in older patients with newly diagnosed cHL.

Patients had varied health histories. Also, studies of BV did not follow patients long enough to determine overall survival.