Reviewing treatment options and outcomes for older patients with classic Hodgkin lymphoma

This study evaluated treatment options and outcomes for older patients with classic Hodgkin lymphoma (HL). This study concluded that conventional chemotherapy regimens remain a standard of care for these patients.

Chemotherapy remains the standard first-line treatment for cHL. One of the most commonly used regimens is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). However, conventional chemotherapy regimens like ABVD have been associated with side effects, especially in older patients. Older patients may also have other medical conditions which may affect their therapy plan and treatment outcomes.

Evaluating older patients before chemotherapy can help guide treatment. A geriatric fitness assessment looks at other medical conditions that a patient may have that could affect their treatment. The real-world outcomes of older patients with these conditions remain under investigation.

This study included 244 patients aged 60 and older. More than half (63%) of patients had advanced (stage 3 or 4) disease. 45% of patients had at least one additional medical condition. 83% of patients received conventional chemotherapy regimens. 56% of patients received ABVD. 14% of patients received AVD (ABVD without bleomycin). 9% of patients received AVD with brentuximab vedotin (BV; Adcetris). Patients were followed up for an average of 3.1 years.

Overall, 83.7% of patients were still alive 3 years later, with 61.8% of patients having no tumor growth or spread.

Patients who had lower geriatric fitness were significantly more likely (2.46-fold) to have tumor growth or spread compared to fit patients. These patients also had a significantly higher risk of mortality (3.58-fold).

Conventional chemotherapy regimens significantly lowered the risk of tumor growth or spread by 54%. These regimens also significantly lowered the risk of mortality by 69%.

52.8% of patients reported infections. 18.4% of patients who received ABVD experienced lung-related side effects. This is a common side effect of the regimen due to bleomycin (Blenoxane). 15% of patients stopped treatment due to side effects.

This study concluded that conventional chemotherapy regimens remain a standard of care for older patients with cHL. The authors suggest that older patients should be evaluated before treatment to ensure that they are fit for chemotherapy.

This study was retrospective, meaning it looked back in time to analyze data. Also, only one patient had a formal geriatric assessment. Data about additional medical conditions had to be collected for all other patients. More studies are needed to determine how geriatric assessments can guide treatment options for patients with cHL.