Abstract T075

Characterisation of older Hodgkin Lymphoma patients using UK registry data from 1997-2023

Introduction: Older (≥60 year old (yo)) patients with classical Hodgkin Lymphoma (cHL) have poorer survival outcomes than younger patients but data are lacking regarding the contribution of treatment-related factors. Methods We examined NHS England registry data regarding British patients diagnosed with cHL between 1997 and 2023 with respect to patient characteristics and chemotherapy regimens used in first-line treatment. Patients were defined on the basis of morphology and International Classification of Diseases (ICD) codes. Patients were categorised by the upfront chemotherapy regimens used, and these regimens were dichotomised into anthracycline-containing and non-anthracycline-containing as a possible surrogate for patient fitness. Survival analyses were performed using the Kaplan-Meier method with log-rank analysis performed to generate p values.

Results: The total number of patients in the survival analysis was 29565, with 8885 (30.05%) aged ≥60yo. Median overall survival (OS) of 18-59yo was not reached, with a median follow up time of 8.8 years. Median OS for 60-69yo was 9.6 years (95% CI 9.0-10.2), 3.0 years (95% CI 2.7-3.4) in 70-79yo and 0.8 years (95% CI 0.7-0.9) in ≥80yo. First-line chemotherapy regimens were recorded in 8872 patients (30.0% of the entire cohort) of whom 2523 were ≥60yo (28.4%). ABVD-like regimens were used in upfront treatment of 1466 (58.1%) of older cHL patients versus 5681 (89.5%) of <60yo. Bleomycin was omitted in 37.9% of older patients receiving ABVD with significantly inferior OS seen in AVD- vs ABVD-treated patients (p=0.0003). ChlVPP was used in 20.8% of older cHL patients, VEPEMB in 6.7% and CHOP-based regimens in 5.5%. Single-agent treatment was delivered to 3.2% of patients and included brentuximab vedotin, chlorambucil and vinblastine. OS for all patients receiving the most frequent combination regimens used is presented in figure 1. In anthracycline-containing regimens, significantly inferior OS was seen with CHOP-like vs ABVD/ AVD regimens (p<0.0005). In non-anthracycline-containing regimens, significantly inferior OS was seen with ChlVPP vs VEPEMB (p<0.0005).

Discussion: Using a large English cohort we confirm that survival is poorer in older than younger cHL patients and that ABVD is associated with improved OS in comparison to other first-line regimens. Work is ongoing to explore other patient factors which may contribute to poorer survival outcomes and explain therapy-related decisions in older cHL patients.

Authors

Aisling Barrett, Zhe Wang, Andrew Challenger, Sarah Darby, John Broggio, David Cutter