The use of ABVD chemotherapy in older patients with early-stage Hodgkin lymphoma

The current study examined the safety and effectiveness of the chemotherapy combination ABVD in early-stage Hodgkin lymphoma patients over the age of 60. This study concluded that the standard four cycles of ABVD led to increased need for dose reduction and increased negative effects in older patients.

While the majority of patients with Hodgkin lymphoma are young adults, approximately 20% of patients are over the age of 60. Older patients have lower 5-year survival rates than do younger patients. Older patients tend to have more aggressive disease. They are also more likely to experience negative side effects from treatments like chemotherapy. These effects can lower the total amount of chemotherapy received by the patient.

Many clinical trials do not include older patients. Standard treatment options are the same as for younger patients. The standard chemotherapy regimen is ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine). This is based on research carried out in younger patients. It is not clear whether ABVD is as safe and effective in older patients as it is in younger patients.

This study examined the outcomes of ABVD treatment in older early-stage Hodgkin lymphoma patients. The study included 117 patients over the age of 60 and 1,182 younger patients. These patients were part of a larger set of trials examining chemotherapy and radiation in Hodgkin lymphoma treatment. Patients were randomly assigned to receive four cycles of ABVD followed by radiation. Patients were followed for an average of 85 months.

93% of older patients received the four cycles of ABVD. Older patients were more likely to need dose reductions and treatment delays. Because of this, only 59% of older patients received a chemotherapy dose of at least 80% of what was intended. In comparison, 85% of younger patients received a chemotherapy dose of at least 80%.

68% of older patients experienced severe side effects. These included nausea, vomiting, infection and low levels of white blood cells. 5% died due to treatment effects. 13% developed a secondary cancer over the 85 month follow-up, compared to 3% of younger patients.

89% of older patients saw a complete response to treatment (absence of cancer) compared to 96% of younger patients. Five-year overall survival (time from treatment until death from any cause) rates were 81% for older patients and 96.9 for younger. 74.8% of older patients were cancer progression free after 5 years, compared to 90.1% of younger patients.

This study concluded that patients over the age of 60 experience more treatment delays and toxicities with four cycles of ABVD treatment than do younger patients.