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McKenna M, Ryu Tiger YK, Rutherford SC, Evens AM. The Management of older patients with Hodgkin lymphoma: implications of S1826. Semin Hematol 2024:S0037-1963(24)00068-4. [PMID: 38945791 DOI: 10.1053/j.seminhematol.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024]
Abstract
Classical Hodgkin lymphoma (cHL) is diagnosed in patients ages 60 and older in approximately 20%-25% of cases in Western populations. Outcomes in this subset of patients have historically been poor, with 5-year progression free survival (PFS) and overall survival rates significantly lower than those seen in younger patients. Challenges to overcome include age-related co-morbidities, and prominent and potentially lethal treatment-related toxicity. There have been increased efforts to study the older cHL patient population, including analysis of geriatric assessments and the integration of newer targeted therapies such as brentuximab vedotin (BV) and nivolumab (N) into treatment paradigms. A recent phase 3 clinical trial (S1826, NCT03907488) led by the North American oncology cooperative groups compared brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (BV-AVD) with nivolumab, doxorubicin, vinblastine, and dacarbazine (N-AVD). At a median follow-up of 1-year, N-AVD improved PFS vs BV-AVD in patients and few immune adverse events were observed. Moreover, in a pre-planned subset analyses of cHL patients ages ≥60 years, the 1-year PFS for N-AVD was 93% (95% CI, 79%-98%) versus 64% (95% CI, 45%-77%) for BV-AVD. In addition, N-AVD was largely better tolerated particularly in older patients, which included markedly less neuropathy, lower treatment discontinuation, and less nonrelapse mortality. As a result, N-AVD is poised to become a standard of care for older, advanced-stage cHL patients who are fit for full-dose anthracycline-based combination therapy. More studies are needed to continue to improve outcomes for older cHL patients, especially unfit and frail populations.
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Affiliation(s)
- Marshall McKenna
- Division of Blood Disorders, Rutgers Cancer Institute, New Brunswick, NJ
| | | | | | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute, New Brunswick, NJ.
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2
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Ghesquières H, Krzisch D, Nicolas-Virelizier E, Kanoun S, Gac AC, Guidez S, Touati M, Laribi K, Morschhauser F, Bonnet C, Waultier-Rascalou A, Orsini-Piocelle F, André M, Fournier M, Morand F, Berriolo-Riedinger A, Burroni B, Damotte D, Traverse-Glehen A, Quittet P, Casasnovas O. The phase 2 LYSA study of prednisone, vinblastine, doxorubicin, and bendamustine for untreated Hodgkin lymphoma in older patients. Blood 2024; 143:983-995. [PMID: 37979133 DOI: 10.1182/blood.2023021564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023] Open
Abstract
ABSTRACT Older patients with classical Hodgkin lymphoma (cHL) require more effective and less toxic therapies than younger patients. In this multicenter, prospective, phase 2 study, we investigated a new firstline therapy regimen comprising 6 cycles of prednisone (40 mg/m2, days 1-5), vinblastine (6 mg/m2, day 1), doxorubicin (40 mg/m2, day 1), and bendamustine (120 mg/m2, day 1) (PVAB regimen) every 21 days for patients with newly diagnosed cHL aged ≥61 years with an advanced Ann Arbor stage. A Mini Nutritional Assessment score ≥17 was the cutoff value for patients aged ≥70 years. The primary end point was the complete metabolic response (CMR) rate after 6 cycles. The median age of the 89 included patients was 68 years (range, 61-88 years), with 35 patients (39%) aged ≥70 years. Seventy-eight patients (88%) completed the 6 cycles. The toxicity rate was acceptable, with a 20% rate of related serious adverse events. CMR was achieved by 69 patients (77.5%; 95% confidence interval [CI], 67-86). After a median follow-up of 42 months, 31 patients progressed or relapsed (35%), and 24 died (27%) from HL (n = 11), toxicity during treatment (n = 4), secondary cancers (n = 6), or other causes (n = 3). The 4-year progression-free survival (PFS) and overall survival rates were 50% and 69%, respectively. Multivariate analysis showed that liver involvement (P = .001), lymphopenia (P = .001), CRP (P = .0005), and comedications (P = .003) were independently associated with PFS. The PVAB regimen yielded a high CMR rate with acceptable toxicity. Over long-term follow-up, survival end points were influenced by unrelated lymphoma events. This trial was registered at www.clinicaltrials.gov as #NCT02414568 and at EudraCT as 2014-001002-17.
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Affiliation(s)
- Hervé Ghesquières
- Department of Hematology, Hopital Lyon Sud, Claude Bernard Lyon 1 University, Pierre Benite, France
| | - Daphné Krzisch
- Department of Hematology, Assistance Publique Hopitaux de Paris, Hopital Saint Louis, Paris, France
| | | | - Salim Kanoun
- Department of Hematology, Cancer Research Center of Toulouse, Team 9, INSERM Unité Mixte de Recherche 1037, Toulouse, France
| | - Anne Claire Gac
- Department of Hematology, Institut d'Hematologie de Basse Normandie, Caen, France
| | - Stéphanie Guidez
- Hematology Department, Centre Hospitalier Universitaire, Poitiers, France
| | - Mohamed Touati
- Department of Hematology, Hôpital Dupuytren, Centre Hospitalier Universitaire, Limoges, France
| | - Kamel Laribi
- Hematology Department, Centre Hospitalier, Le Mans, France
| | - Franck Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire Lille, Universite de Lille, ULR 7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | | | | | | | - Marc André
- Department of Hematology, Centre Hospitalier Universitaire, Université Catholique de Louvain Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Marguerite Fournier
- Department of Statistics, Lymphoma Study Association Clinical Research, Hopital Lyon Sud, Pierre Benite, France
| | - Fabienne Morand
- Department of Statistics, Lymphoma Study Association Clinical Research, Hopital Lyon Sud, Pierre Benite, France
| | | | - Barbara Burroni
- Department of Pathology, Université de Paris Cité, Centre de Recherche des Cordeliers UMRS U1138 et GH Paris Centre APHP, Paris, France
| | - Diane Damotte
- Department of Pathology, Université de Paris Cité, Centre de Recherche des Cordeliers UMRS U1138 et GH Paris Centre APHP, Paris, France
| | | | - Philippe Quittet
- Department of Hematology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and INSERM Unité Mixte de Recherche 1231, Dijon, France
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3
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Evens AM. Hodgkin lymphoma treatment for older persons in the modern era. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:483-499. [PMID: 38066840 PMCID: PMC10727079 DOI: 10.1182/hematology.2023000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
There has been a renewed effort globally in the study of older Hodgkin lymphoma (HL) patients, generating a multitude of new data. For prognostication, advancing age, comorbidities, altered functional status, Hispanic ethnicity, and lack of dose intensity (especially without anthracycline) portend inferior survival. Geriatric assessments (GA), including activities of daily living (ADL) and comorbidities, should be objectively measured in all patients. In addition, proactive multidisciplinary medical management is recommended (eg, geriatrics, cardiology, primary care), and pre-phase therapy should be considered for most patients. Treatment for fit older HL patients should be given with curative intent, including anthracyclines, and bleomycin should be minimized (or avoided). Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, dacarbazine (AVD) chemotherapy for untreated patients is tolerable and effective, and frontline checkpoint inhibitor/AVD platforms are rapidly emerging. Therapy for patients who are unfit or frail, whether due to comorbidities and/or ADL loss, is less clear and should be individualized with consideration of attenuated anthracycline-based therapy versus lower-intensity regimens with inclusion of brentuximab vedotin +/- checkpoint inhibitors. For all patients, there should be clinical vigilance with close monitoring for treatment-related toxicities, including neurotoxicity, cardiopulmonary, and infectious complications. Finally, active surveillance for "postacute" complications 1 to 10 years post therapy, especially cardiac disease, is needed for cured patients. Altogether, therapy for older HL patients should include anthracycline-based therapy in most cases, and novel targeted agents should continue to be integrated into treatment paradigms, with more research needed on how best to utilize GAs for treatment decisions.
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Affiliation(s)
- Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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4
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Goveia L, Castro N, de Souza C, Colaço Villarim C, Traina F, Chiattone CS, Praxedes M, Solza C, Perobelli L, Baiocchi O, Gaiolla R, Boquimpani C, Buccheri V, Bonamin Sola C, de Oliveira Paula E Silva R, Ribas AC, Steffenello G, Pagnano K, Soares A, Souza Medina S, Silveira T, Zattar Cecyn K, Carvalho Palma L, de Oliveira Marques M, Spector N, Biasoli I. Treatment patterns and outcomes for Hodgkin Lymphoma patients aged 60 and older: a report from the Brazilian Prospective Hodgkin Lymphoma Registry. Ann Hematol 2023; 102:2815-2822. [PMID: 37474632 DOI: 10.1007/s00277-023-05352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
The treatment of older patients with Hodgkin lymphoma (HL) remains a challenge. We sought to identify the treatment patterns and outcomes in older HL patients included in the Brazilian HL registry (NCT02589548). A total of 136 patients with HIV-negative classic HL, aged ≥ 60 years, diagnosed between 2009 and 2018, were analyzed. The median age was 66 years old (60-90), 72% had advanced disease, 62% had a high IPS, and 49% had a nodular sclerosis subtype. Median follow-up was 64 months for alive patients. ABVD was the front-line treatment in 96% of patients. Twenty-one patients (15%) died during front-line treatment. The 5-year PFS and 5-year OS rates were 55% and 59%, respectively. The 5-year OS rates in localized and advanced disease were 81% and 51% (p=0.013). Lung toxicity developed in 11% of the patients treated with ABVD. Bleomycin was administered for > 2 cycles in 65% of patients. Compared with 2009-2014, there was a decrease in the use of bleomycin for > 2 cycles in 2015-2018 (88% × 45%, p<0.0001). The impact of socioeconomic status (SES) on outcomes was studied in patients treated with ABVD. After adjusting for potential confounders, lower SES remained independently associated with poorer survival (HR 2.22 [1.14-4.31] for OS and HR 2.84 [1.48-5.45] for PFS). Treatment outcomes were inferior to those observed in developed countries. These inferior outcomes were due to an excess of deaths during front-line treatment and the excessive use of bleomycin. SES was an independent factor for shorter survival.
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Affiliation(s)
- Lilian Goveia
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rua Prof Paulo Rocco 255 - Cidade Universitária, Rio de Janeiro, 21914-913, Brazil
| | - Nelson Castro
- Hospital de Câncer de Barretos, Barretos, São Paulo, Brazil
| | - Carmino de Souza
- Hematology and Hemotherapy Center, University of Campinas, Sao Paulo, Brazil
| | | | - Fabiola Traina
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Monica Praxedes
- Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Cristiana Solza
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Rafael Gaiolla
- Hospital das Clínicas, Faculdade de Medicina de Botucatu, UNESP, Sao Jose, Brazil
| | | | - Valeria Buccheri
- Instituto do Câncer do Estado de São Paulo/Hospital das Clinicas - Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Katia Pagnano
- Hematology and Hemotherapy Center, University of Campinas, Sao Paulo, Brazil
| | - Andrea Soares
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samuel Souza Medina
- Hematology and Hemotherapy Center, University of Campinas, Sao Paulo, Brazil
| | | | | | | | | | - Nelson Spector
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rua Prof Paulo Rocco 255 - Cidade Universitária, Rio de Janeiro, 21914-913, Brazil
| | - Irene Biasoli
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rua Prof Paulo Rocco 255 - Cidade Universitária, Rio de Janeiro, 21914-913, Brazil.
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5
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Miyazaki K. Management of elderly patients with malignant lymphoma. Jpn J Clin Oncol 2022; 52:690-699. [PMID: 35435235 DOI: 10.1093/jjco/hyac056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/02/2022] [Indexed: 11/14/2022] Open
Abstract
More than half of patients with malignant lymphoma are 65 years old or older. The outcome for older patients is poorer than that for younger patients. A poor prognosis is associated with heterogeneity and consists of physical function, performance status, poor nutritional status and various comorbidities. Therefore, attention should be given to serious treatment-related toxicities. Diffuse large B-cell lymphoma is the most frequently diagnosed type of malignant lymphoma. Most patients with diffuse large B-cell lymphoma can be potentially cured with the current standard chemotherapeutic regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone. However, a reduced-dose regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone or alternative treatment options might be suitable for older patients who are frail or unfit and have cardiac comorbidities. A comprehensive geriatric assessment is a potential tool for determining an appropriate therapeutic approach for each older patient. Follicular lymphoma is the second most common type of non-Hodgkin lymphoma, and the disease course is usually characterized by an indolent clinical course. Advanced follicular lymphoma with a high tumor burden has historically been treated with chemoimmunotherapy, but the treatment goal for older patients is relief of symptoms. Incorporating novel targeted agents such as brentuximab vedotin into therapies for older Hodgkin lymphoma patients might be a promising alternative to the anthracycline-containing regimen.
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Affiliation(s)
- Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
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6
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Kieri O, Marrone G, Sönnerborg A, Nowak P. Incidence, Treatment, and Outcome of HIV-Associated Hematologic Malignancies in People Living with HIV in Sweden. AIDS Res Hum Retroviruses 2022; 38:135-142. [PMID: 34652958 DOI: 10.1089/aid.2021.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
People living with HIV (PLHIV) have an increased risk of hematologic malignancies (HMs). We aimed to characterize HMs among PLHIV at Karolinska University Hospital, Stockholm, Sweden. We studied all PLHIV receiving care at our center between 2004 and 2018. Data were retrieved retrospectively from InfCareHIV database and medical records. Around 3,484 patients received HIV care for a total of 22,903 person-years (py) with median follow-up of 7.6 years. HMs were identified in 43 patients with 30 cases of non-Hodgkin lymphoma (NHL), 9 cases of Hodgkin lymphoma (HL), 2 multicentric Castleman's disease, and 1 case each of myeloma and myelodysplastic syndrome. The incidence rate of NHL was 88/105 py and HL 39.6/105 py. The incidence of NHL declined 2004-2010 versus 2011-2018 (180.8 vs. 40.1/105 py; p = .001). Median time from HIV diagnosis to malignancy was shorter in NHL compared with HL (1.2 years vs. 8.9 years; p = .01) and effective HIV treatment was less common in NHL (33% vs. 100%; p < .001). The 5-year survival rate of NHL was 59% and HL 43%, significantly lower compared with lymphoma survival in the general population in Sweden. In the era of effective antiretroviral therapy (ART), the incidence rate of lymphoma was more than five times higher in PLHIV and 5-year survival significantly inferior. Efforts for earlier identification of HIV-infected individuals are likely to affect the incidence of NHL. Additionally, an effective screening for clinical and laboratory signs of HL in PLHIV on ART should be introduced to improve identification and survival of HL in this population.
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Affiliation(s)
- Oscar Kieri
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Gaetano Marrone
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Anders Sönnerborg
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine ANA Futura Laboratory, Karolinska Institute, Stockholm, Sweden
| | - Piotr Nowak
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine ANA Futura Laboratory, Karolinska Institute, Stockholm, Sweden
- The Laboratory for Molecular Infection Medicine Sweden MIMS, Umeå University, Umeå, Sweden
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7
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Wahlin BE, Övergaard N, Peterson S, Digkas E, Glimelius I, Lagerlöf I, Johansson A, Palma M, Hansson L, Linderoth J, Goldkuhl C, Molin D. Real-world data on treatment concepts in classical Hodgkin lymphoma in Sweden 2000-2014, focusing on patients aged >60 years. EJHAEM 2021; 2:400-412. [PMID: 35844675 PMCID: PMC9175745 DOI: 10.1002/jha2.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/08/2022]
Abstract
Treatment for patients > 60 years with classical Hodgkin lymphoma (cHL) is problematic; there is no gold standard, and outcome is poor. Using the Swedish Lymphoma Registry, we analysed all Swedish patients diagnosed with cHL between 2000 and 2014 (N = 2345; median age 42 years; 691 patients were >60 years). The median follow-up time was 6.7 years. Treatment for elderly patients consisted mainly of ABVD or CHOP, and the younger patients were treated with ABVD or BEACOPP (with no survival difference). In multivariable analysis of patients > 60 years, ABVD correlated with better survival than CHOP (p = 0.027), and ABVD became more common over time among patients aged 61-70 years (p = 0.0206). Coinciding with the implementation of FDG-PET/CT, the fraction of advanced-stage disease increased in later calendar periods, also in the older patient group. Survival has improved in cHL patients > 60 years (p = 0.027), for whom ABVD seems superior to CHOP.
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Affiliation(s)
- Björn Engelbrekt Wahlin
- Division of Haematology, Department of Medicine, HuddingeKarolinska InstitutetStockholmSweden
- Haematology unitKarolinska University HospitalStockholmSweden
| | - Ninja Övergaard
- Department of Immunology, Genetics and PathologyUppsala UniversityUppsalaSweden
| | | | | | - Ingrid Glimelius
- Department of Immunology, Genetics and PathologyUppsala UniversityUppsalaSweden
| | - Ingemar Lagerlöf
- Department of Immunology, Genetics and PathologyUppsala UniversityUppsalaSweden
- Department of HaematologyUniversity Hospital of LinköpingLinköpingSweden
| | | | - Marzia Palma
- Haematology unitKarolinska University HospitalStockholmSweden
| | - Lotta Hansson
- Haematology unitKarolinska University HospitalStockholmSweden
| | | | | | - Daniel Molin
- Department of Immunology, Genetics and PathologyUppsala UniversityUppsalaSweden
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8
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Wästerlid T, Oren Gradel K, Eloranta S, Glimelius I, El-Galaly TC, Frederiksen H, Smedby KE. Clinical characteristics and outcomes among 2347 patients aged ≥85 years with major lymphoma subtypes: a Nordic Lymphoma Group study. Br J Haematol 2020; 192:551-559. [PMID: 33236363 PMCID: PMC7894517 DOI: 10.1111/bjh.17250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
There is a lack of data regarding treatment and prognosis for the growing group of oldest old patients with lymphoma. Therefore, we studied 2347 patients aged ≥85 years from the Danish and Swedish lymphoma registers 2000–2016 (Denmark) and 2007–2013 (Sweden). Outcome was assessed using relative survival (RS). The 2‐year RS overall for patients with aggressive lymphomas was 38% [95% confidence interval (CI) 35–42%], of whom 845 (66%) patients received active treatment (chemotherapy, radiotherapy, immunotherapy, other). For aggressive lymphomas, not receiving active treatment was associated with an inferior 2‐year RS of 12% (95% CI 9–17%) compared to 49% (95% CI 45–53%) for patients who received active treatment (excess mortality rate ratio 2·84, 95% CI 2·3–3·5; P < 0·0001). For patients with indolent lymphoma, the 2‐year RS was 77% (95% CI 72–82%). Here, 383 (46%) patients received active treatment at diagnosis, but did not have better 2‐year RS (75%, 95% CI 67–81%) compared to those who did not receive active treatment (83%, 95% CI 74–89%). We conclude that outcomes for the oldest old patients with lymphoma are encouraging for several subtypes and that active treatment is associated with improved outcome amongst the oldest old patients with aggressive lymphomas, indicating that age itself should not be a contraindication to treatment.
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Affiliation(s)
- Tove Wästerlid
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Kim Oren Gradel
- Centre for Clinical Epidemiology, OUH and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN- Odense Patient Data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Sandra Eloranta
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden
| | | | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital (OUH), Odense, Denmark.,Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
| | - Karin E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
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9
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Shakkak F, Kumar S, Hennessy B, Elhassadi E. Elderly Hodgkin's lymphoma-a 10-year single-center experience. Ir J Med Sci 2020; 190:1239-1241. [PMID: 33111252 DOI: 10.1007/s11845-020-02418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Fatima Shakkak
- Haematology Department, University Hospital Waterford, Regional Cancer Center South East, Waterford, Ireland.
| | - Senthil Kumar
- Haematology Department, University Hospital Waterford, Regional Cancer Center South East, Waterford, Ireland
| | - Brian Hennessy
- Haematology Department, University Hospital Waterford, Regional Cancer Center South East, Waterford, Ireland
| | - Ezzat Elhassadi
- Haematology Department, University Hospital Waterford, Regional Cancer Center South East, Waterford, Ireland
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10
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Kobayashi H, Seki R, Ujita M, Hirayama K, Yamada S, Ohashi R, Otsuki Y, Watanabe T, Yoshino T. An Autopsy Case of an Elderly Patient with Classic Hodgkin Lymphoma Presenting with a Plethora of Clinical Symptoms and Signs. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926177. [PMID: 33087692 PMCID: PMC7588351 DOI: 10.12659/ajcr.926177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/14/2020] [Accepted: 07/25/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is a potentially curable disease with favorable outcomes. However, elderly patients with HL usually have more adverse prognostic factors and hence a much worse prognosis than younger patients. CASE REPORT The patient was a woman in her 80s. She reported high fever, anorexia, and a weight loss of 8 kg within 5 months. She had been on treatment for diabetes mellitus and hypertension. She had undergone percutaneous coronary intervention and pacemaker implantation to treat acute coronary syndrome and sinus arrhythmia, respectively. Blood tests showed elevation of alkaline phosphatase, C-reactive protein, leukocyte count, CA 19-9, and carcinoembryonic antigen. Computed tomography did not show tumors in the liver, and cholangitis and sepsis were suspected. Aspartate transaminase, alanine aminotransferase, and total bilirubin gradually increased through the course of the patient's hospital stay. Despite treatment, her condition deteriorated and she died 22 days after hospital admission. At autopsy, we found stage IV HL with lymph node swelling on both sides of the diaphragm, as well as diffusely disseminated nodules in the liver and spleen. CONCLUSIONS Our patient had several poor prognostic factors including B symptoms, comorbidity, advanced stage, Epstein-Barr virus infection, and expression of programmed death-ligand 1 and interleukin-6, all of which were closely connected with her advanced age. Her age and comorbidities may have been the most adverse prognostic factors for her illness. An effective HL screening method for elderly individuals should be developed to ameliorate poor prognosis and adverse outcomes.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Ryouya Seki
- Department of of Gastroenterology, Tachikawa General Hopspital, Nagaoka, Niigata, Japan
| | - Masuo Ujita
- Department of Radiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kana Hirayama
- Department of Dermatology, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan
| | - Satoshi Yamada
- Health Examination Center, Nagaoka Central General Hospital, Nagaoka, Niigata, Japan
| | - Riuko Ohashi
- Histopathology Core Facility, Niigata University School of Medicine, Niigata City, Niigata, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Takuya Watanabe
- Department of General Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University, Okayama City, Okayama, Japan
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11
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Driessen J, Visser O, Zijlstra JM, Lugtenburg PJ, Plattel WJ, Kersten MJ, Dinmohamed AG. Primary therapy and relative survival in classical Hodgkin lymphoma: a nationwide population-based study in the Netherlands, 1989-2017. Leukemia 2020; 35:494-505. [PMID: 32461630 DOI: 10.1038/s41375-020-0875-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 01/17/2023]
Abstract
Population-based studies of classical Hodgkin lymphoma (cHL) in contemporary clinical practice are scarce. The aim of this nationwide population-based study is to assess trends in primary therapy and relative survival (RS) during 1989-2017. We included 9,985 patients with cHL. Radiotherapy alone was virtually not applied as from 2000 among patients aged 18-69 years with stage I/II disease, following the broader application of chemotherapy combined with radiotherapy. Chemotherapy only was the preferred treatment for patients with stage III/IV disease. Throughout the entire study period, around 20% of patients aged ≥70 years across all disease stages received no anti-neoplastic therapy. The most considerable improvements in 5-year RS were confined to patients aged 18-59 years. Five-year RS for patients with stage I/II disease diagnosed during 2010-2017 was 99%, 98%, 100%, 93%, 84%, and 61% for patients aged 18-29, 30-39, 40-49, 50-59, 60-69, and ≥70 years, respectively. The corresponding estimates for stage III/IV disease were 96%, 92%, 90%, 80%, 58%, and 46%. Collectively, the improvements in survival likely relate to advances in cHL management. These achievements, however, do not seem to translate into significant benefits for patients ≥60 years. Therefore, novel therapies are urgently needed to reduce excess mortality in elderly cHL patients.
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Affiliation(s)
- Julia Driessen
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Wouter J Plattel
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
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12
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Rusconi C, Ciavarella S, Fabbri A, Flenghi L, Puccini B, Re A, Sorio M, Vanazzi A, Zanni M. Treatment of very high-risk classical Hodgkin Lymphoma: cases' selection from real life and critical review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:13-22. [PMID: 32525130 PMCID: PMC7944652 DOI: 10.23750/abm.v91is-5.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
Over the last 4 decades, advances in radiation therapy and the addition of combination chemotherapy have significantly increased the cure rate of patients with HL, with a 5-year OS of about 90% . However, despite high rate of cure after first line of therapy, 5%-10% of HLs are refractory to the treatment, and 10-30% of patients have a disease relapse after a complete response (CR). Relapsed HL can be treated with salvage therapies with a long-lasting complete remission in 80% of cases. In recent years, novel drugs are available for the patients with relapsed/refractory HL, like Brentuximab Vedotin and immune checkpoint inhibitors. These drugs have been able to rescue a cohort of patients who subsequently could receive an allogeneic stem-cell transplant. Our cases have been chosen because they are representative of critical issues in the management of relapsed/refractory HL; our experiences are consistent with what reported by other Authors.
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Affiliation(s)
- Chiara Rusconi
- Division of Haematology, Department of Haematology and Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano.
| | - Sabino Ciavarella
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy.
| | | | - Benedetta Puccini
- Haematology Unit, Careggi Hospital-University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Alessandro Re
- Department of Hematology, ASST Spedali Civili di Brescia, Italy.
| | - Marco Sorio
- Department of Clinical and Experimental Medicine, Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy.
| | - Anna Vanazzi
- Division of Clinical Hemato-Oncology, Istituto Europeo di Oncologia, Milan, Italy.
| | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
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13
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Juntikka T, Malila N, Ylöstalo T, Merikivi M, Jyrkkiö S. Epidemiology of classic and nodular lymphocyte predominant hodgkin lymphoma in Finland in 1996-2015. Acta Oncol 2020; 59:574-581. [PMID: 31910680 DOI: 10.1080/0284186x.2019.1711166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: The aim was to describe the incidence and mortality of Hodgkin lymphoma (HL) in Finland in 1996-2015 including classic Hodgkin lymphoma (cHL) subtypes and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL).Material and Methods: This study included 2851 HL cases registered in the population-based Finnish Cancer Registry between 1996 and 2015. All not otherwise specified (NOS) morphology codes were manually checked and re-coded into cHL subtypes or NLPHL according to the International Classification of Diseases for Oncology 2011, if possible. Thereafter, we analyzed the incidence and mortality of HL by age, gender and time trends and by subtypes.Results: According to our registry-based study, the incidence of HL was increasing with a 5-year rate of change of 0.3% (95% confidence interval 0.2-0.5), and the mortality was decreasing with -2.8% (95%CI -3.8 to -1.8) correspondingly. The incidence of nodular sclerosis (NS) was 1.57/100 000 person years (n = 1529) and the incidence and mortality remained constant over 1996-2015. The incidence of mixed cellularity (MC) was 0.32/100 000 (n = 453) and it was decreasing with -2.2% (95%CI -3.7 to -0.5), yet the mortality was increasing with 2.7% (95%CI 1.9-3.6). The incidence of NLPHL was 0.29/100 000 accounting for 13% of all HL diagnoses (n = 374), and the incidence and mortality remained constant over the study period. The incidence of lymphocyte-rich (LR) subtype was 0.20/100 000 (n = 252) and remained constant while the mortality decreased. There were only 30 cases of lymphocyte depletion (LD) HL. In this study, 36% of all HL patients were over 50 years old.Conclusion: The incidence of HL is slightly increasing and the mortality is decreasing in Finland. NLPHL represents 13% of all HL cases in Finland. Over one third of HL patients are over 50-year-old.
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Affiliation(s)
- Tiina Juntikka
- Department of Oncology and Radiotherapy, Turku University Hospital, University of Turku, Turku, Finland
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | | | | | - Sirkku Jyrkkiö
- Department of Oncology and Radiotherapy, Turku University Hospital, University of Turku, Turku, Finland
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14
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Prognostic role of baseline 18F-FDG PET/CT metabolic parameters in elderly HL: a two-center experience in 123 patients. Ann Hematol 2020; 99:1321-1330. [PMID: 32333153 DOI: 10.1007/s00277-020-04039-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/11/2020] [Indexed: 01/20/2023]
Abstract
Elderly Hodgkin lymphoma (HL) is an aggressive lymphoma subgroup with high 18F-FDG avidity at 18F-FDG-PET/CT but no shared criteria for PET/CT in treatment evaluation and prediction of outcome are available. The aim of our bicentric study was to investigate whether the metabolic baseline PET/CT parameters can predict treatment response and prognosis in elderly HL. We retrospectively included 123 patients who underwent baseline 18F-FDG-PET/CT and end of treatment PET/CT scans. The PET images were analyzed visually and semi-quantitatively by measuring the lesion to liver SUVmax ratio (L-L SUV R), lesion to blood-pool SUVmax ratio (L-BP SUV R), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Survival curves were plotted according to the Kaplan-Meier method. At a median follow-up of 40 months, the median PFS and OS were 29 and 37 months. L-BP SUV R, L-L SUV R, MTV, and TLG were significantly higher in patients with no complete response compared with complete response group at end of treatment. Moreover, these parameters were demonstrated to be independent prognostic factors for PFS together with tumor stage, while only L-L SUV R and L-BP SUV R for OS. End of treatment PET/CT results using Deauville criteria were significantly correlated with outcome survival. End of treatment PET/CT results (using Deauville criteria) and semiquantitative baseline PET/CT parameters were significantly correlated with response to treatment and long-term outcome.
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15
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Carter J, David KA, Kritharis A, Evens AM. Current Treatment Options for Older Patients with Hodgkin Lymphoma. Curr Treat Options Oncol 2020; 21:42. [PMID: 32328822 DOI: 10.1007/s11864-020-00745-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Older adults with Hodgkin lymphoma (HL), commonly defined as age ≥ 60 years, represent approximately 20% of the total HL population. Historically, they have significantly inferior outcomes compared with younger patients. The cause of this is multifactorial, including biologic differences (e.g., mixed cellularity and EBV-related disease); high incidence of advanced stage disease; and frequency of comorbidities and decreased organ reserve leading to poorer tolerability of therapy with increased toxicity, including treatment-related mortality. Pretreatment evaluation for older HL patients should entail a geriatric assessment (GA), with evaluation of functional status and comorbidities (e.g., geriatric cumulative illness rating scale, CIRS-G) to determine fitness. Furthermore, treatment selection should be based in part on GA, with fit older patients receiving curative chemotherapy-based regimens and unfit or frail patients considering less intensive or non-chemotherapy-based platforms. Additionally, there may be consideration for pre-phase of therapy (e.g., pulse steroids) in order to improve performance status. The inclusion of anthracycline therapy appears important, while bleomycin-containing regimens (e.g., ABVD) may be associated with prohibitive pulmonary toxicity, and intensive therapies such as BEACOPP are too toxic. benefit ratio/benefit ratio, a priori omission of bleomycin may also be considered (i.e., AVD), especially for patients older than 70 years of age. In addition, newer regimens for older HL patients integrating novel therapeutic agents into frontline treatment have emerged as effective and tolerable options. Data incorporating brentuximab vedotin sequentially before and after AVD chemotherapy represent the best-reported outcomes in older HL patients to date. In the relapsed/refractory setting, salvage chemotherapy regimens followed by autologous stem cell transplantation should be considered for fit patients, while less intensive treatment, including the use of novel targeted agents, is an option for unfit or frail patients. In this review, we examine the epidemiology, importance of GA, and current treatment options for older HL patients.
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Affiliation(s)
- Jordan Carter
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Athena Kritharis
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
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16
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Zhang J, Fan L, Li JY. [Research progress of treatment in Hodgkin lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 40:969-972. [PMID: 31856452 PMCID: PMC7342374 DOI: 10.3760/cma.j.issn.0253-2727.2019.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J Zhang
- Department of Hematology, the First Affiliated Hospital of NanJing Medical University, JiangSu Province Hospital, Nanjing 210029, China
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17
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Lamb MJ, Roman E, Howell DA, Kane E, Bagguley T, Burton C, Patmore R, Smith AG. Hodgkin lymphoma detection and survival: findings from the Haematological Malignancy Research Network. BJGP Open 2019; 3:bjgpopen19X101668. [PMID: 31822492 PMCID: PMC6995857 DOI: 10.3399/bjgpopen19x101668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/08/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma is usually detected in primary care with early signs and symptoms, and is highly treatable with standardised chemotherapy. However, late presentation is associated with poorer outcomes. AIM To investigate the relationship between markers of advanced disease, emergency admission, and survival following a diagnosis of classical Hodgkin lymphoma (CHL). DESIGN & SETTING The study was set within a sociodemographically representative UK population-based patient cohort of ~4 million, within which all patients were tracked through their care pathways, and linked to national data obtained from Hospital Episode Statistics (HES) and deaths. METHOD All 971 patients with CHL newly diagnosed between 1 September 2004-31 August 2015 were followed until 18th December 2018. RESULTS The median diagnostic age was 41.5 years (range 0-96 years), 55.2% of the patients were male, 31.2% had stage IV disease, 43.0% had a moderate-high or high risk prognostic score, and 18.7% were admitted via the emergency route prior to diagnosis. The relationship between age and emergency admission was U-shaped: more likely in patients aged <25 years and ≥70 years. Compared to patients admitted via other routes, those presenting as an emergency had more advanced disease and poorer 3-year survival (relative survival 68.4% [95% confidence interval {CI} = 60.3 to 75.2] versus 89.8% [95% CI = 87.0 to 92.0], respectively [P<0.01]). However, after adjusting for clinically important prognostic factors, no difference in survival remained. CONCLUSION These findings suggest that CHL survival as a whole could be increased by around 4% if the cancer in patients who presented as an emergency had been detected at the same point as in other patients.
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Affiliation(s)
- Maxine Je Lamb
- Research Fellow, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Eve Roman
- Professor, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Debra A Howell
- Senior Research Fellow, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Eleanor Kane
- Research Fellow, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Timothy Bagguley
- Data Analyst, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Cathy Burton
- Consultant Haematologist, Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Russell Patmore
- Consultant Haematologist, Queen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals, Cottingham, UK
| | - Alexandra G Smith
- Reader, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
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18
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Evens AM, Carter J, Loh KP, David KA. Management of older Hodgkin lymphoma patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:233-242. [PMID: 31808898 PMCID: PMC6913478 DOI: 10.1182/hematology.2019000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Hodgkin lymphoma (HL) in older patients, commonly defined as ≥60 years of age, is a disease for which survival rates have historically been significantly lower compared with younger patients. Older HL patients appear to have different disease biology compared with younger patients, including increased incidence of mixed cellularity histology, Epstein-Barr virus-related, and advanced-stage disease. For prognostication, several studies have documented the significance of comorbidities and functional status in older HL patients, as well as the importance of achieving initial complete remission. Collectively, selection of therapy for older HL patients should be based in part on functional status, including pretreatment assessment of activities of daily living (ADL), comorbidities, and other geriatric measures (eg, cognition, social support). Treatment of fit older HL patients should be given with curative intent, regardless of disease stage. However, attention should be paid to serious treatment-related toxicities, including risk of treatment-related mortality. Although inclusion of anthracycline therapy is important, bleomycin-containing regimens (eg, doxorubicin, bleomycin, vinblastine, dacarbazine) may lead to prohibitive pulmonary toxicity, and intensive therapies (eg, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) are too toxic. Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, and dacarbazine to fit, untreated advanced-stage older HL patients was recently shown to be tolerable and highly effective. Therapy for patients who are unfit or frail because of comorbidities and/or ADL loss is less clear and should be individualized with consideration of lower-intensity therapy, such as brentuximab vedotin with or without dacarbazine. Altogether, therapy for older HL patients should be tailored based upon a geriatric assessment, and novel targeted agents should continue to be integrated into treatment paradigms.
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Affiliation(s)
- Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Jordan Carter
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Kah Poh Loh
- Division of Hematology and Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Kevin A David
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
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19
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Weibull CE, Björkholm M, Glimelius I, Lambert PC, Andersson TML, Smedby KE, Dickman PW, Eloranta S. Temporal trends in treatment‐related incidence of diseases of the circulatory system among Hodgkin lymphoma patients. Int J Cancer 2019; 145:1200-1208. [DOI: 10.1002/ijc.32142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/08/2018] [Accepted: 01/08/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Caroline E. Weibull
- Department of Medical Epidemiology and BiostatisticsKarolinska Institutet Stockholm Sweden
| | - Magnus Björkholm
- Division of Haematology, Department of Medicine SolnaKarolinska University Hospital Stockholm Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Experimental and Clinical OncologyUppsala University Uppsala Sweden
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
| | - Paul C. Lambert
- Department of Medical Epidemiology and BiostatisticsKarolinska Institutet Stockholm Sweden
- Biostatistics Research Group, Department of Health SciencesUniversity of Leicester Leicester United Kingdom
| | | | - Karin E. Smedby
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and BiostatisticsKarolinska Institutet Stockholm Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
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20
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Böll B, Plütschow A, Bürkle C, Atta J, Pfreundschuh M, Feuring‐Buske M, Vogelhuber M, Sökler M, Eichenauer DA, Thielen I, Tresckow B, Fuchs M, Engert A, Borchmann P. Doxorubicin, vinblastine, dacarbazine and lenalidomide for older Hodgkin lymphoma patients: final results of a German Hodgkin Study Group (
GHSG
) phase‐I trial. Br J Haematol 2018; 185:42-52. [DOI: 10.1111/bjh.15741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/26/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Boris Böll
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Annette Plütschow
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Carolin Bürkle
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Johannes Atta
- Haematology Oncology University Hospital Frankfurt FrankfurtGermany
| | | | | | - Martin Vogelhuber
- Haematology Oncology University Hospital Regensburg RegensburgGermany
| | - Martin Sökler
- Haematology Oncology University Hospital Tübingen Tübingen Germany
| | - Dennis A. Eichenauer
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Indra Thielen
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Bastian Tresckow
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
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21
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Affiliation(s)
- Boris Böll
- German Hodgkin Study Group and Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
| | - Helen Görgen
- German Hodgkin Study Group and Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
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