Classifying Prognosis as Favorable or Unfavorable

In younger patients, clinicians can use fluorodeoxyglucose (FDG)-PET and computed tomography (CT) to categorize patients into risk groups that are used to determine optimal treatment modality and intensity. However, clinicians must also conduct a comprehensive geriatric assessment in older patients, as comorbidities can help guide treatment decisions and also have prognostic value.

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In older patients, dose intensity for first-line treatment is a critical decision that can affect therapy delays and overall survival, according to the authors. Using a scoring system based on risk factors for early relapse, clinical stage of disease, and presence of anemia, patients with HL could be classified as having favorable or unfavorable prognosis. Multivariate analysis of treatment strategy at relapse or progression showed that patients in the low-risk category benefited from the conventional polychemotherapy plus salvage radiotherapy approach. However, there was no difference in overall survival between patients in the high-risk category who received chemotherapy plus radiotherapy compared with intensified or palliative treatment, indicating only limited benefit from intensified salvage treatment.

Dr Samaniego cautioned that no single treatment works for all patients; it is important to closely monitor patients after initiating treatment and to make quick adjustments. “When treating the elderly, clinicians [must] improve their threshold for early detection of complications after chemotherapy, such as infection, blood clot, and appearance of medical complications commonly see in the elderly population,” he said. “Clinicians should be ready to reduce [the dose of] chemotherapy when they start seeing toxicity, [which can] improve the patient’s chance of recovery to baseline after a toxicity or complication.”

For now, clinicians face uncertainties in treating older patients with relapsed or refractory HL because of the scarcity of studies specifically addressing this group of patients. As a possible solution, Dr Böll and Ms Görgen proposed collaboration between various study groups to establish new treatment strategies for these patients.

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1. Böll B, Görgen H. The treatment of older Hodgkin lymphoma patients [published online November 8, 2018]. Br J Haematol. doi: 10.1111/bjh.15652