Skip to main content
SpringerLink
Log in

Hodgkin Lymphoma in the Elderly

  • Chapter
  • First Online:
Management of Hematological Cancer in Older People

  • 783 Accesses

Abstract

The treatment of Hodgkin Lymphoma has continued to improve, however the advances achieved in younger patients have not been replicated in elderly group affected with this disease. The reasons for this are multifactorial, and in part due to the presence of co-morbid illness, the inability to tolerate therapies which are curative in younger age cohorts, poor functional status and intrinsic biological disease characteristics which differ between the older and younger patient. As a result fewer elderly patients are entered into clinical trials, and there exists no uniform consensus as how to treat the elderly patient off trial. Because of this, urgent new therapies are required to treat the elderly patient, which still may offer the chance of long term survival whilst minimising particularly for the elderly patient, any attendant short term toxicities. This review examines the results of previous chemotherapy directed approaches, summarises the results of more recent chemotherapeutic approaches, and finally examines the encouraging recent results incorporating targeted biological approaches which may ultimately deliver improved outcomes for the elderly patient affected with this disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Erdkamp FL, Breed WP, Bosch LJ, Wijnen JT, Blijham GB. Hodgkin disease in the elderly. A registry-based analysis. Cancer. 1992;70(4):830–4. Epub 1992/08/15.

    Article  CAS  PubMed  Google Scholar 

  2. Weekes CD, Vose JM, Lynch JC, Weisenburger DD, Bierman PJ, Greiner T, et al. Hodgkin’s disease in the elderly: improved treatment outcome with a doxorubicin-containing regimen. J Clin Oncol. 2002;20(4):1087–93. Epub 2002/02/15.

    Article  CAS  PubMed  Google Scholar 

  3. Diepstra A, van Imhoff GW, Schaapveld M, Karim-Kos H, van den Berg A, Vellenga E, et al. Latent Epstein-Barr virus infection of tumor cells in classical Hodgkin’s lymphoma predicts adverse outcome in older adult patients. J Clin Oncol. 2009;27(23):3815–21. Epub 2009/05/28.

    Article  PubMed  Google Scholar 

  4. Keegan TH, Glaser SL, Clarke CA, Gulley ML, Craig FE, Digiuseppe JA, et al. Epstein-Barr virus as a marker of survival after Hodgkin’s lymphoma: a population-based study. J Clin Oncol. 2005;23(30):7604–13. Epub 2005/09/28.

    Article  PubMed  Google Scholar 

  5. Stark GL, Wood KM, Jack F, Angus B, Proctor SJ, Taylor PR, et al. Hodgkin’s disease in the elderly: a population-based study. Br J Haematol. 2002;119(2):432–40. Epub 2002/10/31.

    Article  PubMed  Google Scholar 

  6. Enblad G, Sandvej K, Sundstrom C, Pallesen G, Glimelius B. Epstein-Barr virus distribution in Hodgkin’s disease in an unselected Swedish population. Acta Oncol. 1999;38(4):425–9. Epub 1999/07/27.

    Article  CAS  PubMed  Google Scholar 

  7. Gandhi MK, Tellam JT, Khanna R. Epstein-Barr virus-associated Hodgkin’s lymphoma. Br J Haematol. 2004;125(3):267–81. Epub 2004/04/17.

    Article  CAS  PubMed  Google Scholar 

  8. Herbst H, Samol J, Foss HD, Raff T, Niedobitek G. Modulation of interleukin-6 expression in Hodgkin and Reed-Sternberg cells by Epstein-Barr virus. J Pathol. 1997;182(3):299–306. Epub 1997/07/01.

    Article  CAS  PubMed  Google Scholar 

  9. Herbst H, Foss HD, Samol J, Araujo I, Klotzbach H, Krause H, et al. Frequent expression of interleukin-10 by Epstein-Barr virus-harboring tumor cells of Hodgkin’s disease. Blood. 1996;87(7):2918–29. Epub 1996/04/01.

    CAS  PubMed  Google Scholar 

  10. Friedberg JW, Fischman A, Neuberg D, Kim H, Takvorian T, Ng AK, et al. FDG-PET is superior to gallium scintigraphy in staging and more sensitive in the follow-up of patients with de novo Hodgkin lymphoma: a blinded comparison. Leuk Lymphoma. 2004;45(1):85–92. Epub 2004/04/06.

    Article  PubMed  Google Scholar 

  11. Hutchings M, Loft A, Hansen M, Pedersen LM, Berthelsen AK, Keiding S, et al. Position emission tomography with or without computed tomography in the primary staging of Hodgkin’s lymphoma. Haematologica. 2006;91(4):482–9. Epub 2006/04/06.

    PubMed  Google Scholar 

  12. Hutchings M, Loft A, Hansen M, Pedersen LM, Buhl T, Jurlander J, et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood. 2006;107(1):52–9. Epub 2005/09/10.

    Article  CAS  PubMed  Google Scholar 

  13. Engert A, Ballova V, Haverkamp H, Pfistner B, Josting A, Duhmke E, et al. Hodgkin’s lymphoma in elderly patients: a comprehensive retrospective analysis from the German Hodgkin’s Study Group. J Clin Oncol. 2005;23(22):5052–60. Epub 2005/06/16.

    Article  PubMed  Google Scholar 

  14. Enblad G, Glimelius B, Sundstrom C. Treatment outcome in Hodgkin’s disease in patients above the age of 60: a population-based study. Ann Oncol. 1991;2(4):297–302. Epub 1991/04/01.

    CAS  PubMed  Google Scholar 

  15. Landgren O, Algernon C, Axdorph U, Nilsson B, Wedelin C, Porwit-MacDonald A, et al. Hodgkin’s lymphoma in the elderly with special reference to type and intensity of chemotherapy in relation to prognosis. Haematologica. 2003;88(4):438–44. Epub 2003/04/19.

    PubMed  Google Scholar 

  16. Evens AM, Helenowski I, Ramsdale E, Nabhan C, Karmali R, Hanson B, et al. A retrospective multicenter analysis of elderly Hodgkin lymphoma: outcomes and prognostic factors in the modern era. Blood. 2012;119(3):692–5. Epub 2011/11/26.

    Article  CAS  PubMed  Google Scholar 

  17. Proctor SJ, Wilkinson J, Jones G, Watson GC, Lucraft HH, Mainou-Fowler T, et al. Evaluation of treatment outcome in 175 patients with Hodgkin lymphoma aged 60 years or over: the SHIELD study. Blood. 2012;119(25):6005–15. Epub 2012/05/12.

    Article  CAS  PubMed  Google Scholar 

  18. Levis A, Anselmo AP, Ambrosetti A, Adamo F, Bertini M, Cavalieri E, et al. VEPEMB in elderly Hodgkin’s lymphoma patients. Results from an Intergruppo Italiano Linfomi (IIL) study. Ann Oncol. 2004;15(1):123–8.

    Article  CAS  PubMed  Google Scholar 

  19. Guinee VF, Giacco GG, Durand M, van den Blink JW, Gustavsson A, McVie JG, et al. The prognosis of Hodgkin’s disease in older adults. J Clin Oncol. 1991;9(6):947–53. Epub 1991/06/01.

    CAS  PubMed  Google Scholar 

  20. van Spronsen DJ, Janssen-Heijnen ML, Breed WP, Coebergh JW. Prevalence of co-morbidity and its relationship to treatment among unselected patients with Hodgkin's disease and non-Hodgkin’s lymphoma, 1993–1996. Ann Hematol. 1999;78(7):315–9. Epub 1999/08/31.

    Article  PubMed  Google Scholar 

  21. Boll B, Gorgen H, Fuchs M, Pluetschow A, Eich HT, Bargetzi MJ, et al. ABVD in older patients with early-stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD10 and HD11 trials. J Clin Oncol. 2013;31(12):1522–9. Epub 2013/03/20.

    Article  PubMed  Google Scholar 

  22. Fehniger TA, Larson S, Trinkaus K, Siegel MJ, Cashen AF, Blum KA, et al. A phase 2 multicenter study of lenalidomide in relapsed or refractory classical Hodgkin lymphoma. Blood. 2011;118(19):5119–25. Epub 2011/09/23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Halbsguth TV, Nogova L, Mueller H, Sieniawski M, Eichenauer DA, Schober T, et al. Phase 2 study of BACOPP (bleomycin, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) in older patients with Hodgkin lymphoma: a report from the German Hodgkin Study Group (GHSG). Blood. 2010;116(12):2026–32. Epub 2010/06/17.

    Article  CAS  PubMed  Google Scholar 

  24. Evens AM, Hong F, Gordon LI, Fisher RI, Bartlett NL, Connors JM, et al. The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients: a comprehensive analysis from the North American intergroup trial E2496. Br J Haematol. 2013;161(1):76–86. Epub 2013/01/30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Ballova V, Ruffer JU, Haverkamp H, et al. A prospectively randomized trial carried out by the German Hodgkin Study Group (GHSG) for elderly patients with advanced Hodgkin`s disease coamparing BEACOPP baseline and COPP-ABVD (study HD9eldery). Ann Oncol. 2005;16:124–31.

    Article  CAS  PubMed  Google Scholar 

  26. Wongso D, Fuchs M, Plutschow A, Klimm B, Sasse S, Hertenstein B, et al. Treatment-related mortality in patients with advanced-stage Hodgkin lymphoma: an analysis of the German Hodgkin Study Group. J Clin Oncol. 2013;31(22):2819–24. Epub 2013/06/26.

    Article  PubMed  Google Scholar 

  27. Levis A, Depaoli L, Urgesi A, Bertini M, Orsucci L, Vitolo U, et al. Probability of cure in elderly Hodgkin’s disease patients. Haematologica. 1994;79(1):46–54. Epub 1994/01/01.

    CAS  PubMed  Google Scholar 

  28. Levis A, Merli F, Tamiazzo S, et al. ABVD versus VEPEMB in elderly Hodgkin`s lymphoma patient [Abstract]. Blood. 2007;110:2322.

    Google Scholar 

  29. Boll B, Bredenfeld H, Gorgen H, Halbsguth T, Eich HT, Soekler M, et al. Phase 2 study of PVAG (prednisone, vinblastine, doxorubicin, gemcitabine) in elderly patients with early unfavorable or advanced stage Hodgkin lymphoma. Blood. 2011;118(24):6292–8. Epub 2011/09/16.

    Article  PubMed  Google Scholar 

  30. Kolstad A, Nome O, Delabie J, Lauritzsen GF, Fossa A, Holte H. Standard CHOP-21 as first line therapy for elderly patients with Hodgkin’s lymphoma. Leuk Lymphoma. 2007;48(3):570–6. Epub 2007/04/25.

    Article  CAS  PubMed  Google Scholar 

  31. Younes A, Bartlett NL, Leonard JP, Kennedy DA, Lynch CM, Sievers EL, et al. Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas. N Engl J Med. 2010;363(19):1812–21. Epub 2010/11/05.

    Article  CAS  PubMed  Google Scholar 

  32. Younes A, Gopal AK, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ, et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin’s lymphoma. J Clin Oncol. 2012;30(18):2183–9. Epub 2012/03/29.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Younes A, Sureda A, Ben-Yehuda D, Zinzani PL, Ong TC, Prince HM, et al. Panobinostat in patients with relapsed/refractory Hodgkin’s lymphoma after autologous stem-cell transplantation: results of a phase II study. J Clin Oncol. 2012;30(18):2197–203. Epub 2012/05/02.

    Article  CAS  PubMed  Google Scholar 

  34. Moskowitz AJ, Hamlin Jr PA, Perales MA, Gerecitano J, Horwitz SM, Matasar MJ, et al. Phase II study of bendamustine in relapsed and refractory Hodgkin lymphoma. J Clin Oncol. 2013;31(4):456–60. Epub 2012/12/19.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Katz J, Janik JE, Younes A. Brentuximab Vedotin (SGN-35). Clin Cancer Res. 2011;17(20):6428–36. Epub 2011/10/18.

    Article  CAS  PubMed  Google Scholar 

  36. Buglio D, Georgakis GV, Hanabuchi S, Arima K, Khaskhely NM, Liu YJ, et al. Vorinostat inhibits STAT6-mediated TH2 cytokine and TARC production and induces cell death in Hodgkin lymphoma cell lines. Blood. 2008;112(4):1424–33. Epub 2008/06/11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Martin WG, Ristow KM, Habermann TM, Colgan JP, Witzig TE, Ansell SM. Bleomycin pulmonary toxicity has a negative impact on the outcome of patients with Hodgkin’s lymphoma. J Clin Oncol. 2005;23(30):7614–20. Epub 2005/09/28.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Haematology, Guy’s and St Thomas’ and Kings College Hospitals, Kings Health Partners AHSC, London, UK

    Paul Fields MD

Authors
  1. Paul Fields MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Fields MD .

Editor information

Editors and Affiliations

  1. Department of Palliative Care, University Hospital Jena, Jena, Thüringen, Germany

    Ulrich Wedding

  2. St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom

    Riccardo A. Audisio

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Fields, P. (2015). Hodgkin Lymphoma in the Elderly. In: Wedding, U., Audisio, R. (eds) Management of Hematological Cancer in Older People. Springer, London. https://doi.org/10.1007/978-1-4471-2837-3_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2837-3_10

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2836-6

  • Online ISBN: 978-1-4471-2837-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation