Abstract P024

Anthracycline-containing regimens confer better survival in risk-matched, advanced stage older patients with classic Hodgkin lymphoma; comorbidity, not age, predicts cardiac toxicity

Introduction: Older (≥60 year old (y)) patients with classical Hodgkin lymphoma (cHL) have worse outcomes than their younger counterparts. The interplay between comorbidities, treatment choice and outcomes has been incompletely examined.

Methods: This is a retrospective cohort study with contribution from 24 UK sites. Eligible ≥60y cHL patients were diagnosed from 2010-23. Baseline factors were compared using Kruskal Wallis and Fisher’s exact tests. Overall survival (OS) and event-free survival (EFS) were assessed using Kaplan-Meier survival analysis with groups compared using Cox regression. Binary endpoints were compared using logistic regression.

Results: A total of 1011 eligible patients were registered to the study: 645 receiving anthracycline-containing chemotherapy (anthra), 202 multiagent chemotherapy without anthra (non-anthra), 48 single-agent, 31 radiotherapy alone and 85 with no treatment. Anthra was used more commonly and radiotherapy less commonly in the more recent era (2020-23 p=0.002 compared to pre-2020). Anthra patients had lower CIRS-G score at diagnosis (p<0.0001).

The median follow up was 5.3 years. OS and EFS varied significantly by CIRS-G score at baseline, treatment groups and type of chemotherapy delivered (all p<0.0001). Upfront dose modification was more common in the non-anthra group (p=0.002), older patients (p<0.0001), prior cardiac history (p=0.016) and higher CIRS-G score (p=0.007); it did not protect against later treatment changes when groups were adjusted for age, CIRS-G and treatment group. There was increased risk of treatment-related cardiac toxicity if prior cardiac history, but only in the non-anthra group (p=0.0092). CIRSG with omission of cardiac scores was more predictive in anthra but the interaction was not significant (p=0.11). No significant difference was seen with increasing age (p=0.15). There was increased risk of infectious admission in the non-anthra group (p=0.002), higher CIRS-G score (p=0.008) and increased age at diagnosis (p=0.005). When advanced stage patients were matched for international prognostic score factors, CIRS-G and age band the non-anthra group had inferior OS (HR 1.59, p=0.021) and EFS (1.45, p=0.046) compared to anthra.

Discussion: Anthracycline use is preferable in older cHL patients. A comorbidity-focused approach to treatment selection may improve outcomes whilst maintaining acceptable toxicity.