Abstract P082

Elderly Classical Hodgkin Lymphoma: Croatian Cooperative Group for Hematological Diseases (KroHem) Experience

Introduction: Classical Hodgkin lymphoma (cHL) poses unique challenges in elderly patients, necessitating tailored treatment due to age-related comorbidities and decreased tolerance to intensive therapies. This study aims to analyze the demographics, treatment modalities, and survival outcomes of elderly cHL patients treated at KroHem centers. Methods: We identified 147 patients aged ≥60 years, diagnosed between 2011 and 2024, for retrospective analysis. We recorded patient demographics, disease characteristics, first-line treatment modalities, and treatment responses. Overall survival (OS) and event-free survival (EFS) were estimated using Kaplan-Meier methods, with comparisons between groups performed using log-rank tests.

Results: The median age of the cohort was 69 years (range 60-91), with 65% male. Patients presented with advanced stage (AS) disease in 64%, early favorable (EF) in 19%, and early unfavorable (EU) disease in 17%. Extranodal involvement was seen in 33%, and bulky disease in 12% of patients. Curative-intent anthracycline-based therapy was given to 86%, and 27% received radiotherapy. Only 24.5% received all planned treatment cycles. Of 134 patients evaluable for response assessment, 94 achieved CR, 14 PR, and 19 did not respond. Treatment-related mortality was 11.6%. After a median follow-up of 51 months, 2-year, 3-year, and 5-year OS and EFS rates were 74%, 68% and 68%; and 62%, 52% and 43%, respectively. Anthracycline-based treatment significantly improved median survival (86 months) compared to palliative care (11 months) (p < .001). Significant differences in OS and EFS were observed across age groups (p < .001), with mean OS and EFS decreasing from 76 and 60 months in patients aged 60-69 years to 22 and 22 months in those aged 80 years and older. Performance status and physician-evaluated frailty also significantly impacted OS and EFS, while sex, disease stage, and CIRS-G did not.

Conclusion: In this difficult-to-treat population, age, ECOG status, and frailty were significant predictors of survival, with older age groups and higher ECOG stages showing markedly reduced OS and EFS. These factors likely influenced first-line treatment choices, leading to extended survival with anthracycline-based treatment compared to less intensive regimens. Our results align with other studies on elderly cHL patients, highlighting the need for tailored treatment approaches considering patient age and frailty.

Authors

Ida Hude Dragičević, Ida Ivek, Sandra Bašić-Kinda, Karla Mišura Jakobac, Marija Ivić Čikara, Marija Petrić, Vlatka Periša, Ivana Vučinić Ljubičić, Ivana Sušac Zrna, Ivan Krečak, Dina Mokwa, Tomislav Čolak, Barbara Dreta, Dino Dujmović, Igor Aurer