AVD - a possible golden standard in the first-line treatment of older classical Hodgkin lymphoma patients.
First-line treatment in patients ≥60 years with classical Hodgkin lymphoma (cHL) is challenging and less well studied compared to younger patients. Although survival has improved over the past decades, older patients still have an inferior outcome and no golden standard in first-line treatment exists. These patients often have a higher comorbidity-burden and are more susceptible to acute toxicity. In addition, the ageing body and an increased incidence of more advanced disease makes curative treatment challenging.
We collected patient and treatment data from Sweden, Denmark and Norway for 1554 patients aged ≥60 years at cHL diagnosis who received treatment with curative intent, diagnosed from January 1st, 2000 to December 30th, 2021 from national registries. Data was also collected from patient records. Survival was estimated using Kaplan-Meyer curves and the risk of death was estimated with both univariable and multivariable Cox regression analysis. Patients were grouped according to first-line chemotherapy regimen; ABVD (n=671), AVD (n=122), CHOP (n=465) or “other” (n=296, single agent or combination chemotherapy).
Median age was 70 years (60-94 years) for all patients and stages. In the different treatment groups the median age was 66 years (60-90), 74 years (61-86), 73 years (60-92), 73 years (60-94) for ABVD, AVD, CHOP and “other”, respectively. Overall survival (OS) at 5 years for limited stage patients was 85% for the ABVD group, 94% for AVD, 64% for CHOP and 48% for patients who received “other” chemotherapy. A majority of limited stage patients also received radiotherapy. In patients with advanced stage disease 5-year OS was 63% in the ABVD group, 64% for AVD, 46% for CHOP and 39% in the “other”-group. In multivariable OS analysis patients treated with CHOP had a significantly poorer outcome than those treated with AVD, while there was no significant difference between AVD and ABVD. The majority of patients receiving AVD were treated in Sweden after 2016 and patients in the CHOP and other-group generally had poorer performance status compared to the ABVD-group. PFS data will be presented.
AVD is less toxic than ABVD, as bleomycin is omitted, and outcome with respect to OS was equal to ABVD and superior to CHOP in this patient group. Based on our findings AVD is a preferable treatment and should be considered as backbone in prospective studies with novel drugs.