Standard Treatment Suboptimal for Elderly with Hodgkin’s Lymphoma

The standard chemotherapy regimen used to treat patients with Hodgkin’s lymphoma (HL) may prove to be too toxic and less effective for elderly patients compared to their younger counterparts. These results were recently published in the Journal of Clinical Oncology.

Hodgkin’s lymphoma, also referred to as Hodgkin’s disease, is a cancer that involves cells of the immune system. The National Cancer Institute estimates approximately 9,300 new cases of HL in 2013 in the United States. Approximately 20% of these cases occur in the elderly, or those who are 65 years of age and older.

Standard chemotherapy for HL consists of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine). Although cure rates overall are high for HL, this particular regimen can be difficult to tolerate due to side effects. As elderly patients experience greater side effects from specific therapies, researchers continue to evaluate different therapeutic approaches for this group of patients.

Severe side effects may necessitate delays of administration of therapy or reduction of doses which can ultimately reduce the effectiveness of therapy. Furthermore, severe side effects can place the patient in jeopardy of experiencing serious medical issues or even death. Therefore, individualizing therapeutic approaches for each patient group provides optimal outcomes and is an area of active research.

Researchers from Germany recently evaluated ABVD treatment among elderly HL patients. The researchers compared data from approximately 1,300 patients with HL who were treated with ABVD in the German Hodgkin Study Group (GHSG) HD10 and HD11 trials. Patients were who between 60 and 75 years of age were compared to those who were younger than 60 years.

Only 59% of elderly patients received an acceptable dose and timing (dose-intensity) of ABVD, compared with 85% of younger patients.
The mean delay of treatment was twice as high in elderly patients compared to younger patients.
Mortality from treatment occurred in 5% of elderly, compared with only 0.3% in younger patients.
Complete remission occurred in 96% of younger patients and only in 89% of elderly patients
Overall survival was 97% in younger patients and 90% in elderly patients.
The researchers concluded that ABVD for elderly patients with early HL may not be the optimal therapeutic approach. Studies are currently underway exploring different treatment options for this group of patients.

Reference: Boll B, Gorgen H, Fuchs M, et al. ABVD in Older Patients with Early-Stage Hodgkin Lymphoma Treated within the German Hodgkin Study Group HD10 and HD11 Trials. Journal of Clinical Oncology. March 18, 2013; doi:10.1200/JCO.2012.45.4181.