Treatment patterns and outcomes for Hodgkin's Lymphoma (HL) patients (pts) aged 60 and older: a report from the Brazilian Prospective Hodgkin’s lymphoma Registry
Despite substantial progress in the treatment of HL, older pts remain an unmet treatment need.
We sought to identify the treatment patterns and outcomes in HL pts ≥ 60 y/o included in the Brazilian HL registry.
A total of 141 pts with HIV negative classical HL aged ≥ 60, diagnosed from January 2009 to December 2018, were identified. Five pts were excluded, leaving 136 pts available for analysis.
The median age was 66 years old (60-90), 49% were female, PS >1 in 21%, advanced stage in 72%, anemia in 38%, high-risk IPS score in 62% and nodular sclerosis (NS) in 49%. In comparison to younger pts, pts ≥ 60 y/o were more likely to have a high‐risk IPS score (63% vs 38%, P<.0001), and histopathology other than NS (51% vs 23%, P<.0001). Also, older pts were more likely to have a lower socioeconomic status (SES, 47% vs 30%, P< .0001) and a lower educational level (25% vs 3%, P<.0001).
Median follow-up was 45 months (0-144) for all pts and 64 months (14-144) for pts alive. ABVD was the first-line treatment in 96% of pts. Twenty-one pts (15%) died during the first treatment. In 18 (86%) of these pts, the cause of death was an infection or a complication of treatment. The 5-year PFS and 5-year OS were 55% and 59%. The 5-year PFS in localized and advanced disease were 72% and 47% (P=0.013). The 5-year OS in localized and advanced disease were 81% and 51% (P =0.013).
Among 131 pts treated with ABVD, 5% presented cardiac toxicity, 11% lung toxicity and 12% severe infection. 65% of pts used bleomycin for > 2 cycles and 44% for > 4 cycles. In comparison with 2009-2014, there was a decrease in the use of bleomycin for > 2 cycles in 2015-2018 (88% x 45%, P<0.0001).
The impact of (SES) on outcomes was studied in pts treated with ABVD. The fatality ratio during treatment was 9% and 21% for higher and lower SES (P=0.10). The 5‐year PFS for higher and lower SES were 71% and 46% (P = .005), and the 5‐year OS 72% and 55% (P = .027), respectively. After adjustments 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).
Advanced stage and poor-risk pts predominated. Inferior outcomes are in part due to advanced disease at diagnosis and to an excess of deaths during treatment. SES is an independent factor for shorter survival. The use of bleomycin remains high, despite a substantial decrease in recent years.