Clinical characteristics and outcome of patients over 60 years with Hodgkin lymphoma treated in Switzerland.

Moccia, A A; Aeppli, S; Güsewell, S; Bargetzi, M; Caspar, C; Brülisauer, D; Ebnöther, M; Fehr, M; Fischer, N; Ghilardi, G; Krasniqi, F; Lang, N; Mey, U; Mingrone, W; Novak, U; Pfleger, C; Richter, P; Rütti, M; Schmidt, A; Stenner, F; ... (2021). Clinical characteristics and outcome of patients over 60 years with Hodgkin lymphoma treated in Switzerland. Hematological oncology, 39(2), pp. 196-204. Wiley 10.1002/hon.2830

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Hodgkin lymphoma (HL) in older patients appears to be a different disease compared with younger patients with historically lower survival rates. This is related to a variety of factors, including increased treatment-related toxicity, the presence of comorbidities, and biologic differences. In order to better assess the clinical characteristics, treatment strategies, and outcome of this particular population, we conducted a population-based, retrospective analysis including 269 patients with HL older than 60 years (median age 71 years, range 60-94), treated between 2000 and 2017 in 15 referral centers across Switzerland. Primary endpoints were overall survival (OS), progression-free survival (PFS), and cause-specific survival (CSS). The vast majority of patients were treated with curative intent, either with a combined modality approach (chemotherapy followed by radiation therapy) or with systemic therapy. At a median follow-up of 6.6 years (95% confidence interval [CI], 6.0-7.6), 5-year PFS was 52.2% (95% CI, 46.0-59.2), 5-year OS was 62.5% (95% CI, 56.4-69.2), and 5-year CSS was 85.1.8% (95% CI, 80.3-90.1) for the entire cohort. A significant difference in terms of CSS was observed for patients older than 71 years in comparison to patients aged 60-70 years (hazard ratio 2.6, 1.3-5.0, p = 0.005). Bleomycin-induced lung toxicity (BLT) was documented in 26 patients (17.7%) out of the 147 patients exposed to this compound and was more frequent in patients older than 71 years (15/60, 25%). Outcome of HL pts older than 71 years appeared to decrease substantially in comparison to the younger counterpart. Treatment-related toxicities appeared to be relevant, in particular, BLT. New, potentially less toxic strategies need to be investigated in prospective clinical trials in this particular frail population.

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