BACKGROUND: Hodgkin lymphoma (HL) typically affects young adults, although there is a second peak in incidence later in life, with patients over the age of 60 years. Advanced age is known as a poor prognostic factor, that has been attributed to a variety of factors, like comorbodities, poor functional status, which may affect the toleration of treatment. METHODS: We retrospectively analyzed data of patients with HL over the age of 60 years who were diagnosed and treated between January 1, 2010, and December 31, 2023, at the Division of Haematology, University of Debrecen. The diagnostic efficiency of different independent variables was determined by Receiver Operating Characteristic (ROC) analysis and then calculated by the Youden Index. The impact of the variables on endpoints (overall survival–OS, progression-free survival–PFS) was examined using the Cox proportional hazards regression model.
RESULTS: A total number of 35 patients over 60 years of age were treated, with a median age of 68 (range 60-88) years. 60% of patients were under the age of 70 years. 9 patients aged between 70-79 years, and 5 patients over the age of 80 years. The most common histological subtype (40%) was nodular sclerosis. 66% of the patients had B symptoms. 72% of the patients were in an advanced stage at the time of diagnosis. Under the age of 70 years, 86% received ABVD treatment, among 70-79 years, 56% received ABVD treatment, 60% of patients between 80-89 years received BV plus DTIC treatment. Almost 90% of all patients had some form of comorbidity. 26% of all patients have died. Comorbidities significantly worsened survival chances. Based on the Charlson Comorbidity Index, patients with >7 points had significantly worse 5-year PFS (93% vs. 54%, p=0.024). Platelet count over 310.5 G/L and low absolute lymphocyte count (LYM# <0.47 G/L) were found to be independent risk factors for OS. Each parameter, both individually and in combination, significantly affected OS. For PFS, white blood cell count over 8.48 G/L, platelet count over 310.5 G/L and advanced age (>73.5 years) were confirmed as significant adverse prognostic factors. Each of these parameters, both individually and in combination, significantly influenced PFS.
CONCLUSION: The survival and treatability of older HL patients are not determined significantly by their age, but by their general condition. The presence of comorbidities affects PFS. The use of innovative treatments is expected to improve survival outcomes.
Dávid Tóthfalusi, László Imre Pinczés, Boglárka Dobó, Árpád Illés, Zsófia Miltényi