Abstract T074

A simplified frailty score predicts outcome in older patients with classical Hodgkin lymphoma treated with curative intent

Background: Standard treatment for classical Hodgkin lymphoma (cHL) is poorly tolerated by older patients and outcomes are suboptimal. Host-related factors such as age, comorbidities and frailty are likely to impact on outcome.

Methods: We retrospectively analyzed patient and disease characteristics, treatment choices and outcomes in a population-based Norwegian cohort of cHL patients ≥60 years (ys), diagnosed 2000-2015 and treated with curative intent, defined by use of typical anthracycline-based regimens with ≥50% doxorubicin of full dose in the first cycle. Primary endpoints were overall survival (OS) and progression-free survival (PFS). We used Cox regression analysis to identify patient factors associated with OS and PFS and developed a frailty score.

Results: 279 patients (median age 69 ys, range 60-90) were included. Treatment-related mortality was 7.5% and median PFS and OS were 7.1 ys (95%CI 5.0-9.3) and 8.7 ys (95%CI 7.0-10.4), respectively. Among disease-related parameters, advanced stage (≥IIB versus ≤IIA; hazard ratio (HR) 2.2; 95%CI 1.3-3.6; p=0.003) and lymphocyte-rich versus nodular sclerosis histology (HR 0.2; 95%CI 0.1-0.7; p=0.009) were independently associated with PFS. Independent associations with PFS were found for the patient-related variables age (≥70 versus <70 ys; HR 1.7; 95%CI 1.1-2.5; p=0.012), Eastern Cooperative Oncology Group (ECOG) performance status (≥2 versus <2; HR 1.6; 95%CI 1.0-2.5; p=0.037) and Cumulative Illness Rating Scale Geriatrics (CIRS-G) score (≥8 versus <8, HR 1.7; 95%CI 1.2-2.5; p=0.007). A frailty index with one point each for age, ECOG status and CIRS-G score above these thresholds let us categorize patients as fit (score 0; 33.8% of all patients), unfit (1-2; 59.5%) or frail (3, 6.6%). Five-year PFS rates in fit, unfit and frail patient were 74% (95%CI 65-83), 49% (95%CI 42-58) and 11% (95%CI 3-41), respectively, the score being predictive also for OS and in early and advanced stage patients separately (Figure 1). In internal 10-fold cross-validation, the C-index was 0.69 for PFS and 0.70 for OS. Nearly all fit patients received doxorubicin ≥80% of full dose in the first cycle. Unfit patients given ≥80% doxorubicin had superior 5-year PFS (p=0.004) and OS (p=0.005) compared to those with <80% in the first cycle.

Conclusion: We developed a frailty score predicting 5-year PFS and OS in elderly cHL patients independently of disease-related findings. External validations of the frailty index are ongoing.