Hodgkin lymphoma (HL) is an aggressive malignant blood disorder with a higher incidence in adolescents and the elderly (70-80 years). Young patients with HL had higher cure rates, with a 5-year overall survival (OS) rate of more than 85 percent, while older patients with HL had a poorer prognosis with a 5-year OS rate of less than 60 percent. Poor prognosis in older patients with HL may be associated with biological factors, treatment-related toxic side effects, and aggressive treatment intentions. At present, the first-line treatment regimen for HL patients, especially young HL patients, is mainly multi-drug chemotherapy regimens, such as ABVD regimens or enhanced BEACOPP regimens, with or without combination of radiotherapy. The number of cycles of chemotherapy regimens varies depending on the stage of the disease in patients with HL, early treatment remission, and ability to tolerate chemotherapy. Elderly patients with HL, particularly those with comorbidities, may not be able to tolerate multi-drug chemotherapy regimens and are usually treated with a reduced dose chemotherapy regimen or palliative therapy.
Although survival is worse in older patients than in younger HL patients, older patients with HL still have the opportunity to improve prognosis with appropriate treatment. However, current HL-related studies have less explored the association between treatment regimen intensity and patient prognosis. A retrospective cohort study used the SEER-Medicare database to explore the association between treatment regimen intensity and cause-specific mortality in older HL patients. The main results of the study are summarized below for the reference of a wide range of readers.
Research methodology
The cohort study included patients diagnosed with HL from the SEER-Medicare database between 1999 and 2016, ≥ 65 years of age at the time of diagnosis. Patients included in HL require a follow-up of at least 3 years to obtain 3 years of survival data.
Research results
Basic patient information
A total of 2686 patients with HL were included in the study, with an average age of 75.7 years, of which 1333 (50%) were male. 1307 patients (49%) had early HL and 1379 (51%) had advanced HL. The geographical characteristics of patients at different stages of the disease are similar, but there are some differences in the disease characteristics and treatment of patients at different stages of the disease. Compared with the 2686 patients included in the analysis, the 317 patients excluded from the analysis were older (79.0 years vs 75.7 years), had higher levels of weakness (frailty score: 26.5 versus 15.3), had poor comorbidity (comorbidity score: 3 versus 1.8), and had a late disease stage (stage IV HL patients: 140 [44%] vs 632 [24%]).
Relationship between treatment regimens and mortality from specific causes in early HL patients
After 3 years of treatment, 228 patients died of HL, 281 died of other causes, and 798 patients survived. Older HL patients who received reduced intensity regimens (HR: 1.77; 95% CI: 1.22-2.57) or no treatment (HR: 1.91; 95% CI: 1.31-2.79) had a higher risk of HL death than older HL patients treated with a normal intensity regimen, while older HL patients who received monotherapy or radiotherapy had no difference in the risk of HL death due to HL compared with older HL patients who received multi-drug combination regimens (HR: 1.37; 95% CI：0.92-2.06）。 Older HL patients treated with a reduced intensity regimen (HR: 1.69; 95% CI: 1.18-2.44) or no treatment (HR: 2.71; 95% CI: 1.95-3.78) were equally at higher risk of dying from other causes compared with older HL patients treated with the normal intensity regimen.
Relationship between treatment regimens and mortality from specific causes in patients with advanced HL
After 3 years of treatment, 357 patients died of HL, 380 died of other causes, and 624 survived. Older HL patients treated with a reduced intensity regimen (HR: 3.26; 95% CI: 2.44-4.35), monotherapy or radiation therapy (HR: 2.85; 95% CI: 1.98-4.11), and no treatment (HR: 4.06; 95% CI: 3.06-5.37) were at higher risk of HL death compared with older patients treated with normal intensity regimens. Older HL patients treated with reduced intensity regimens (HR: 1.76; 95% CI: 1.32-2.33), monotherapy or radiation therapy (HR: 1.65; 95% CI: 1.15-2.37), and no treatment (HR: 2.24; 95% CI: 1.71-2.94) were also at higher risk of dying from other causes than older patients treated with normal intensity regimens.
Conclusions of the study
The study showed that the association between treatment regimen intensity and mortality in HL patients varied by HL disease stage and cause. Older patients with HL who can tolerate treatment with a normal-intensity chemotherapy regimen have a better prognosis. Clinically, it is necessary to choose the appropriate treatment plan according to the age, weakness, comorbidities, and treatment preferences of elderly HL patients, so as to bring better prognosis to elderly HL patients.
Resources:
Angie Mae Rodday, Theresa Hahn, AnitaJ. Kumar, et al. Association of Treatment Intensity With Survival in Older Patients With Hodgkin Lymphoma. JAMA NetwOpen. 2021; 4(10): e2128373.