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In a cohort of older patients with classical Hodgkin lymphoma (cHL), modifications in ABVD or CHOP regimens due to toxicity or comorbidities were common, according to an observational study presented at the Virtual Edition of the 25th European Hematology Association (EHA) Annual Congress.
“Survival in elderly patients is still low; this is even more pronounced for stage III and IV disease,” Julia Driessen, of the University of Amsterdam, and lead author and presenter of the study, said. The purpose of this study was to evaluate trends in the primary treatment of this population and corresponding survival in older patients.
This population-based study included 2328 patients 60 years or older diagnosed with cHL between 1989 and 2017 with follow-up data to 2019 from the Netherlands Cancer Registry. A subset of 371 patients who were diagnosed between 2014 and 2017 had detailed data of their treatment. Relative survival (RS) at 5 years and multivariate analyses were conducted to identify any associated prognostic factors.
The median patient age was 70 years, and 54% of patients were male. A total of 49% of patients were Ann Arbor stage III/IV, which was higher among patients diagnosed between 2010 and 2017 (60%) than between 2000 and 2009 (48%) or 1989 and 1999 (39%). Driessen said that this may be due to the adoption of PET-CT for staging.
The majority of patients who received chemotherapy were treated with ABVD followed by CHOP. In the cohort of patients with detailed treatment data, 33% of patients aged 60 to 69 years and 35% of patients older than 69 years with stage I/II disease underwent treatment modification. Among patients with stage III/IV disease, 62% of patients aged 60 to 69 years and 68% of patients older than 69 years underwent treatment modification.
“The reasons for treatment adaptations were nearly all because of toxicity,” Driessen said.
Excess mortality was 30% lower among patients diagnosed with cHL between 2010 and 2017 compared with patients diagnosed between 2000 and 2009 (excess mortality ratio, 0.70; 95% CI, 0.60-0.82; P <.001). Shorter RS was associated with older age and disease stage.
Driessen said that “most patients are treated with ABVD or CHOP according to guideline recommendations, but the majority does not receive the recommended number of cycles or have dose reductions or not all drugs are given, mostly because of toxicity.”
Driessen J et al. Primary therapy and relative survival in patients aged 60 years and older with classical Hodgkin lymphoma: a nationwide, population-based study in the Netherlands, 1989-2017. Paper Presented at: Virtual Edition of the 25th European Hematology Association (EHA) Annual Congress; June 2020. Abstract S223.
This article originally appeared on Cancer Therapy Advisor