Treatment options for elderly patients with Hodgkin lymphoma

This article reviewed current treatment options for elderly patients with Hodgkin lymphoma (HL).

There are two main types of Hodgkin’s lymphoma. These include classical HL (cHL) and nodular lymphocyte-predominant HL (NLPHL). NLPHL is the rarer of these two types. Chemotherapy and radiation are the foundations of treatment for cHL. Combination chemotherapy regimens like ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) are the main standard of care.

HL often affects young adults, but a significant number of patients in clinical practice are over age 60. About 20% of all patients with HL are in this age group. Unfortunately, with few clinical trials including elderly patients, treatment remains challenging.

Previous studies have suggested that there are significant differences in outcomes between elderly versus younger patients. In one study, patients with early-stage HL received ABVD chemotherapy followed by radiotherapy. Significantly more patients aged 60 or older had serious side effects compared to younger patients (40% vs. 21%). One such side effect was serious infections (12% vs. 4%). More patients aged 60 or older also had the cancer come back or spread compared to younger patients.

In a phase 2 study, 59 elderly patients were treated with PVAG (prednisone, vinblastine, doxorubicin, gemcitabine) chemotherapy. 46 patients had a complete disappearance of all signs of cancer. On average, 66% of patients were still alive 3 years later, with 58% of patients still alive without tumor growth or spread. At an average of 37 months after treatment, 15 patients had tumor growth or spread.

Targeted therapy may be another treatment option for elderly patients with HL. Brentuximab vedotin is a monoclonal antibody. This type of targeted therapy binds to cancer cells and blocks their growth. This leads to cancer cell death. In another phase 2 study, 48 elderly patients received brentuximab vedotin (Adcetris). 82% of patients responded to treatment. 36% of patients had a complete disappearance of all signs of cancer. After further treatment with chemotherapy, this rate was 90%. 2 years later, 93% of patients were still alive. 84% of patients were still alive without tumor growth or spread.

This article reviewed current treatment options for elderly patients with HL. More studies are needed to evaluate treatments for patients with recurrent or non-responsive HL.