Outcomes in elderly hodgkin lymphoma: results from korean multicenter cohort

Introduction: Hodgkin lymphoma (HL) is a rare disease especially in Asian known to have good prognosis. However, in elderly patients (pts), due to comorbidities and poorer tolerance to treatment, the survival rate is not as good as in younger pts. This study aims to enhance understanding of current status of elderly HL pts in Korea. Methods: We analyzed a total of 159 HL pts who were diagnosed between 1999 and 2018 from 16 medical centers in Korea retrospectively. Pts aged 60 years (yrs) or older were included and clinical data were collected. Results: The median age at diagnosis was 69 yrs (range 60–85) and male was predominant (n = 110, 69.2%). More than half were between the ages of 60 to 69 yrs (n = 86, 54.1%), 39.6% (n = 63) was between 70 to 79 yrs, 6.2% (n = 10) was older than 80 yrs. Forty-eight pts (30.2%) had at least 2 comorbidities or prior malignancy history. Advanced disease as Lugano stage III and IV were presented in 72.3% (n = 115) of patients. Pts with absence of B symptoms (n = 99, 62.3%), non-bulky disease (n = 152, 95.6%) and absence of bone marrow involvement (n = 109, 68.5%) were predominant. Elevation of lactate dehydrogenase (LDH) was observed in 44.0% (n = 70). Most of pts (n = 143, 89.9%) presented CD30 positive malignant cells. Among 159 pts, 1 was cured by radiotherapy alone and the other 158 received induction chemotherapy. Median 5 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) was the most common first (1st) line treatment (n = 148, 93.1%). The average dose intensity of ABVD was 86.7% for each cycle. Average intensity of bleomycin dosage was 84.9% for each cycle and 41.9% (n = 62) of pts received reduced dose of bleomycin. Except 39 pts whose treatment responses were not evaluable, response rate including complete remission and partial remission after 1st line therapy was 96.7% in total population. Thirty pts received second (2nd) line chemotherapy. The major cause of not proceeding to 2nd line therapy was continuous remission after 1st treatment (n = 75, 58.1%). Grade 3, 4 adverse events (AE) were observed in 46.8% (n = 74). Cytopenia was the most common grade 3, 4 AE. Among 148 pts who received ABVD induction, pneumonitis was observed in 27.0% (n = 40) and among these pts, 55.0% presented grade 3, 4 AE. The 1st 3-yr progression-free survival rate was 73.1% (95% confidence interval [CI], 63.38–80.64) and 5-yr overall survival (OS) was 65.1% (95% CI 55.53–73.04). B symptom (hazard ratio [HR] 1.96, p = 0.016), poor performance status (HR 1.95, p = 0.000), elevated LDH (HR 1.17, p = 0.031), relapse/refractory disease (HR 1.27, p = 0.000), pulmonary AE (HR 2.50, p = 0.001) were adverse factors for OS. Keyword: Hodgkin lymphoma No conflicts of interests pertinent to the abstract.