Abstract T002

Simplified Geriatric Assessment (sGA) in Older Patients With Classical Hodgkin Lymphoma (cHL): The Prospective ELDHL Project of the Fondazione Italiana Linfomi (FIL)

Background: Older patients (pts) with cHL generally have a poor prognosis, due to both inferior disease control and increased treatment(tx)-related toxicity. Recently, novel first-line txs have improved pts outcomes through enhanced efficacy. In this context, accurate stratification of functional status is crucial to identify pts who may benefit from standard versus alternative txs. The FIL sGA is based on chronological age and on determination of Activities of Daily Living (ADL), Instrumental ADL and Cumulative Illness Rating Scale for Geriatrics (CIRS-G). It is an easy-to-use tool that has proven to effectively stratify pts in the setting of DLBCL

Pupose: To prospectively validate the use of sGA at diagnosis for older pts with cHL

Methods: We conducted the prospective ELDHL study including pts aged >64 years with cHL who underwent FIL-sGA before tx. Tx choice was left to the physician’s discretion. The endpoints were Overall Survival (OS) and Progression Free Survival (PFS) with the aim of developing a potential new prognostic model

Results: A total of 311 consecutive pts were analyzed (median age 74 years, range 65-91; 56% males). At baseline, 68% had advanced stage disease, 39% B symptoms, 34% extranodal sites, 10% bulky disease. According to sGA, pts were classified as fit (58%), unfit (27%) and frail (15%). Most pts received ABVD-like tx (95% of fit, 81% of unfit, and 50% of frail pts, respectively). In the whole cohort, Overall Response Rate (ORR) was 70.2%, with a Complete Response Rate (CRR) of 61.7%. At a median follow up of 39 months, 5-year PFS was 52% (95% CI, 44 to 58%), and 5-year OS 63% (95% CI, 55 to 71%). Outcomes significantly differed across sGA categories: ORR was 76%, 67% and 50% (p=0.010), CRR 66%, 61% and 41% (p=0.021), 5-year OS 75%, 54%, and 25% (p<0.001), and 5-year PFS 59%, 51% and 18% (p<0.001), in fit, unfit, and frail pts, respectively. After adjusting for Ann Arbor stage, in advanced stage cHL pts sGA stratification maintained its prognostic power in terms of both 5-year OS (70%, 47% and 11%; p< 0.001) and 5-year PFS (52%, 51% and 12%; p<0.001), in fit, unfit and frail pts, respectively

Conclusion: In older pts with cHL, the definition of fitness status by sGA allowed to stratify pts into three distinct categories (fit, unfit, and frail) associated with significantly different survival outcomes. The prognostic role of sGA was independent from other risk factors and particularly relevant for pts with advanced stage disease