Abstract P025

Validation of the Hodgkin lymphoma Simplified Frailty Score for Patients Receiving Modern Regimens

Background: Treatment of classic Hodgkin lymphoma (cHL) in older patients (≥ 60 years) is challenging due to frailty, comorbidities, and poor tolerance to standard therapies. Front-line regimens incorporating either brentuximab vedotin (BV) or nivolumab (nivo) demonstrated improved outcomes. A simplified frailty score combining age (≥70), Charlson Comorbidity Index (CCI (0-2 vs 3 or higher)), and Eastern Cancer Oncology Group (ECOG ≥2) predicted outcomes in older patients treated with conventional curative treatment (Lia, et al. Haematologica 2025). We assessed the utility of the simplified frailty score in patients treated with newer regimens containing either BV or nivo.

Methods: We identified consecutive patients age ≥ 60 at the time of cHL diagnosis treated with curative-intent treatment consisting of BV or nivo in combination (or sequentially) with AVD chemotherapy, treated from June 2014 to February 2025. Each frailty criterion contributed one point for an index ranging from fit (0), unfit (1-2), and frail (3). The primary outcomes were progression-free survival (PFS) and overall survival (OS) analyzed using Kaplan-Meier methods and log-rank tests.

Results: Among 75 patients, median age was 69 (60 - 82); 29 (39%) received nivo-based therapy and 46 (61%) BV-based (67% sequential; 33% combined). There were 31 (41%) fit patients, 43 (57%) unfit patients, and one frail patient. 5-year PFS and OS were 65% and 85%, respectively. The 5-year PFS for fit and unfit patients were 74% and 59% (p=0.10); the 5-year OS were 100% and 72% (p=0.009). Treatment with nivo-based, BV-sequential, or BV-combined therapy was associated with 5-year PFS of 80%, 54%, and 53%, respectively (p=0.16 for nivo-based vs BV-sequential, p=0.039 for nivo-based vs BV-combination). For unfit patients, PFS was significantly improved for patients treated with nivo-based therapy compared to BV-based therapy (5-year PFS 91% vs 43%, p = 0.039), however OS was not significantly different (5-year OS 89% vs 61%, p = 0.24). For fit patients, outcomes were similar regardless of treatment; 5-year PFS, OS were 74%, 100% and 78%, 100%, for patients treated with nivo-based therapy and BV-based therapy, respectively (Figure).

Conclusion: These findings aid in validating the simplified frailty score in patients treated with modern therapy and suggest that nivo-based therapy is particularly beneficial for unfit elderly patients. Treatment choice is less likely to impact outcomes for fit patients.