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The Management of Older Patients with Hodgkin Lymphoma

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Hodgkin Lymphoma

Part of the book series: Hematologic Malignancies ((HEMATOLOGIC))

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Abstract

Survival rates for Hodgkin lymphoma (HL) have substantially improved during the past several decades. Using stage-adapted polychemotherapy regimens and innovative radiation techniques, 5-year progression-free survival (PFS) has reached almost 90 % in young patients. Since the median age at diagnosis is approximately 32 years, these excellent results account for the majority of patients. Unfortunately, this progress has not translated into a similar benefit for older patients, especially for advanced-stage disease. Survival rates for HL patients aged ≥60 years are significantly and disproportionately inferior compared with younger patient populations.

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References

  1. Diehl V, Franklin J, Pfreundschuh M et al (2003) Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. N Engl J Med 348:2386–2395

    Article  CAS  PubMed  Google Scholar 

  2. Horning SJ, Hoppe RT, Breslin S et al (2002) Stanford V and radiotherapy for locally extensive and advanced Hodgkin’s disease: mature results of a prospective clinical trial. J Clin Oncol 20:630–637

    Article  PubMed  Google Scholar 

  3. Radford JA, Rohatiner AZ, Ryder WD et al (2002) ChlVPP/EVA hybrid versus the weekly VAPEC-B regimen for previously untreated Hodgkin’s disease. J Clin Oncol 20:2988–2994

    Article  CAS  PubMed  Google Scholar 

  4. Austin-Seymour MM, Hoppe RT, Cox RS et al (1984) Hodgkin’s disease in patients over sixty years old. Ann Intern Med 100:13–18

    Article  CAS  PubMed  Google Scholar 

  5. Engert A, Ballova V, Haverkamp H et al (2005) Hodgkin’s lymphoma in elderly patients: a comprehensive retrospective analysis from the German Hodgkin’s study group. J Clin Oncol 23:5052–5060

    Article  PubMed  Google Scholar 

  6. Weekes CD, Vose JM, Lynch JC et al (2002) Hodgkin’s disease in the elderly: improved treatment outcome with a doxorubicin-containing regimen. J Clin Oncol 20:1087–1093

    Article  CAS  PubMed  Google Scholar 

  7. Enblad G, Glimelius B, Sundström C (1991) Treatment outcome in Hodgkin’s disease in patients above the age of 60: a population-based study. Ann Oncol 2:297–302

    CAS  PubMed  Google Scholar 

  8. Erdkamp FL, Breed WP, Bosch LJ et al (1992) Hodgkin disease in the elderly. A registry-based analysis. Cancer 70:830–834

    Article  CAS  PubMed  Google Scholar 

  9. Evens AM, Sweetenham JW, Horning SJ (2008) Hodgkin lymphoma in older patients: an uncommon disease in need of study. Oncology (Williston Park, NY) 22:1369–1379

    Google Scholar 

  10. Stark GL, Wood KM, Jack F et al (2002) Hodgkin’s disease in the elderly: a population-based study. Br J Haematol 119:432–440

    Article  PubMed  Google Scholar 

  11. Proctor SJ, Rueffer JU, Angus B et al (2002) Hodgkin’s disease in the elderly: current status and future directions. Ann Oncol 13(Suppl 1):133–137

    Article  PubMed  Google Scholar 

  12. Hamlin PA (2007) Treatment of aggressive non-Hodgkin’s and Hodgkin’s lymphoma in older patients. Am Soc Clin Oncol 12:295–299

    Google Scholar 

  13. Hurria A, Gupta S, Zauderer M et al (2005) Developing a cancer-specific geriatric assessment: a feasibility study. Cancer 104:1998–2005

    Article  PubMed  Google Scholar 

  14. Parkin DM, Muir CS (1992) Cancer incidence in five continents. Comparability and quality of data. IARC Sci Publ 120:45–173

    PubMed  Google Scholar 

  15. Taylor PR, Angus B, Owen JP et al (1998) Hodgkin’s disease: a population-adjusted clinical epidemiology study (PACE) of management at presentation. Northern Region Lymphoma Group. QJM 91:131–139

    Article  CAS  PubMed  Google Scholar 

  16. Miller T, LeBlanc M, Braziel R et al (2002) Was the bimodal age incidence of Hodgkin’s lymphoma a result of mistaken diagnosis of non-Hodgkin’s lymphoma? Blood 100(771a) (abstract 3048)

    Google Scholar 

  17. Evens AM, Antillon M, Aschebrook-Kilfoy B et al (2012) Racial disparities in Hodgkin’s lymphoma: a comprehensive population-based analysis. Ann Oncol 23:2128–2137

    Article  CAS  PubMed  Google Scholar 

  18. Mir R, Anderson J, Strauchen J et al (1993) Hodgkin disease in patients 60 years of age or older. Histologic and clinical features of advanced-stage disease. The Cancer and Leukemia Group B. Cancer 71:1857–1866

    Article  CAS  PubMed  Google Scholar 

  19. Roy P, Vaughan Hudson G, Vaughan Hudson B et al (2000) Long-term survival in Hodgkin’s disease patients. A comparison of relative survival in patients in trials and those recorded in population-based cancer registries. Eur J Cancer 36:384–389

    Article  CAS  PubMed  Google Scholar 

  20. Landgren O, Algernon C, Axdorph U et al (2003) Hodgkin’s lymphoma in the elderly with special reference to type and intensity of chemotherapy in relation to prognosis. Haematologica 88:438–444

    PubMed  Google Scholar 

  21. Proctor SJ, White J, Jones GL (2005) An international approach to the treatment of Hodgkin’s disease in the elderly: launch of the SHIELD study programme. Eur J Haematol Suppl 66:63–67

    Article  PubMed  Google Scholar 

  22. Evens AM, Hong F (2013) How can outcomes be improved for older patients with Hodgkin lymphoma? J Clin Oncol 31(12):1502–1505

    Article  PubMed  Google Scholar 

  23. Evens AM, Helenowski I, Ramsdale E et al (2012) A retrospective multicenter analysis of elderly Hodgkin lymphoma: outcomes and prognostic factors in the modern era. Blood 119:692–695

    Article  CAS  PubMed  Google Scholar 

  24. Jarrett RF, Stark GL, White J et al (2005) Impact of tumor Epstein-Barr virus status on presenting features and outcome in age-defined subgroups of patients with classic Hodgkin lymphoma: a population-based study. Blood 106:2444–2451

    Article  CAS  PubMed  Google Scholar 

  25. Evens AM, Hong F, Gordon LI et al (2013) 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 161:76–86

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. van Spronsen DJ, Janssen-Heijnen ML, Breed WP et al (1999) 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 78:315–319

    Article  PubMed  Google Scholar 

  27. Levis A, Anselmo AP, Ambrosetti A et al (2004) VEPEMB in elderly Hodgkin’s lymphoma patients. Results from an intergruppo Italiano linfomi (IIL) study. Ann Oncol 15:123–128

    Article  CAS  PubMed  Google Scholar 

  28. Guinee VF, Giacco GG, Durand M et al (1991) The prognosis of Hodgkin’s disease in older adults. J Clin Oncol 9:947–953

    CAS  PubMed  Google Scholar 

  29. Levis A, Depaoli L, Urgesi A et al (1994) Probability of cure in elderly Hodgkin’s disease patients. Haematologica 79:46–54

    CAS  PubMed  Google Scholar 

  30. Kim HK, Silver B, Li S et al (2003) Hodgkin’s disease in elderly patients (>or =60): clinical outcome and treatment strategies. Radiat Oncol Biol 56:556–560

    Article  Google Scholar 

  31. Specht L, Nissen NI (1989) Hodgkin’s disease and age. Eur J Haematol 43:127–135

    Article  CAS  PubMed  Google Scholar 

  32. Ballova V, Ruffer JU, Haverkamp H et al (2005) A prospectively randomized trial carried out by the German Hodgkin Study Group (GHSG) for elderly patients with advanced Hodgkin’s disease comparing BEACOPP baseline and COPP-ABVD (study HD9elderly. Ann Oncol 16:124–131

    Article  CAS  PubMed  Google Scholar 

  33. Enblad G, Gustavsson A, Sundström C et al (2002) Patients above sixty years of age with Hodgkin’s lymphoma treated with a new strategy. Acta Oncol 41:659–667

    Article  PubMed  Google Scholar 

  34. Levis A, Depaoli L, Bertini M et al (1996) Results of a low aggressivity chemotherapy regimen (CVP/CEB) in elderly Hodgkin’s disease patients. Haematologica 81:450–456

    CAS  PubMed  Google Scholar 

  35. Zinzani PL, Magagnoli M, Bendandi M et al (2000) Efficacy of the VBM regimen in the treatment of elderly patients with Hodgkin’s disease. Haematologica 85:729–732

    CAS  PubMed  Google Scholar 

  36. Macpherson N, Klasa RJ, Gascoyne R et al (2002) Treatment of elderly Hodgkin’s lymphoma patients with a novel 5-drug regimen (ODBEP): a phase II study. Leuk Lymphoma 43:1395–1402

    Article  CAS  PubMed  Google Scholar 

  37. Martin WG (2005) Bleomycin pulmonary toxicity has a negative impact on the outcome of patients with Hodgkin’s lymphoma. J Clin Oncol 23:7614–7620

    Article  CAS  PubMed  Google Scholar 

  38. Adach K, Suzuki M, Sugimoto T et al (2002) Granulocyte colony-stimulating factor exacerbates the acute lung injury and pulmonary fibrosis induced by intratracheal administration of bleomycin in rats. Exp Toxicol Pathol 53:501–510

    Article  PubMed  Google Scholar 

  39. Azoulay E, Herigault S, Levame M et al (2003) Effect of granulocyte colony-stimulating factor on bleomycin-induced acute lung injury and pulmonary fibrosis. Crit Care Med 31:1442–1448

    Article  CAS  PubMed  Google Scholar 

  40. Matthews JH (1993) Pulmonary toxicity of ABVD chemotherapy and G-CSF in Hodgkin’s disease: possible synergy. Lancet 342:988

    Article  CAS  PubMed  Google Scholar 

  41. Böll B, Görgen H, Fuchs M et al (2013) ABVD in older patients with early-stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD10 and HD11 trials. J Clin Oncol 31:1522–1529

    Article  PubMed  Google Scholar 

  42. Klimm B, Eich HT, Haverkamp H et al (2007) Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin’s lymphoma: an analysis from the German Hodgkin Study Group. Ann Oncol 18:357–363

    Article  CAS  PubMed  Google Scholar 

  43. Landgren O (2006) A population-based cohort study on early-stage Hodgkin lymphoma treated with radiotherapy alone: with special reference to older patients. Ann Oncol 17:1290–1295

    Article  CAS  PubMed  Google Scholar 

  44. Kolstad A, Nome O, Delabie J et al (2007) Standard CHOP-21 as first line therapy for elderly patients with Hodgkin’s lymphoma. Leuk Lymphoma 48:570–576

    Article  CAS  PubMed  Google Scholar 

  45. Hagemeister FB (2007) Hodgkin’s lymphoma in younger patients: lessons learned on the road to success. Oncol (Williston Park, NY) 21:434–440; discussion 441–442– 445–446

    Google Scholar 

  46. Engert A, Diehl V, Franklin J et al (2009) Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin’s lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol 27:4548–4554

    Article  PubMed  Google Scholar 

  47. Walker A, Schoenfeld ER, Lowman JT et al (1990) Survival of the older patient compared with the younger patient with Hodgkin’s disease. Influence of histologic type, staging, and treatment. Cancer 65:1635–1640

    Article  CAS  PubMed  Google Scholar 

  48. Halbsguth TV, Nogova L, Mueller H et al (2010) 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 116:2026–2032

    Article  CAS  PubMed  Google Scholar 

  49. Böll B, Bredenfeld H, Görgen H et al (2011) Phase 2 study of PVAG (prednisone, vinblastine, doxorubicin, gemcitabine) in elderly patients with early unfavorable or advanced stage Hodgkin lymphoma. Blood 118:6292–6298

    Article  PubMed  Google Scholar 

  50. Proctor SJ, Wilkinson J, Jones G et al (2012) Prospective evaluation of treatment outcome in 175 patients with Hodgkin Lymphoma (HL) aged sixty years or over: the SHIELD study. Blood 119:6005–6015

    Article  CAS  PubMed  Google Scholar 

  51. Levis A, Merli F, Tamiazzo S et al (2007) ABVD versus VEPEMB in elderly hodgkin’s lymphoma patients. Blood 110:Abstract 2322

    Google Scholar 

  52. Canellos GP, Duggan D, Johnson J et al (2004) How important is bleomycin in the adriamycin + bleomycin + vinblastine + dacarbazine regimen? J Clin Oncol 22:1532–1533

    Article  PubMed  Google Scholar 

  53. Gallamini A, Hutchings M, Rigacci L et al (2007) Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin’s lymphoma: a report from a joint Italian-Danish study. J Clin Oncol 25:3746–3752

    Article  CAS  PubMed  Google Scholar 

  54. Hutchings M, Loft A, Hansen M et al (2006) FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood 107:52–59

    Article  CAS  PubMed  Google Scholar 

  55. Younes A, Gopal AK, Smith SE et al (2012) Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin’s lymphoma. J Clin Oncol 30:2183–2189

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Johnston PB, Inwards DJ, Colgan JP et al (2010) A phase II trial of the oral mTOR inhibitor everolimus in relapsed Hodgkin lymphoma. Am J Hematol 85:320–324

    CAS  PubMed  Google Scholar 

  57. Fehniger TA, Larson S, Trinkaus K et al (2011) A phase 2 multicenter study of lenalidomide in relapsed or refractory classical Hodgkin lymphoma. Blood 118:5119–5125

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Lennard AL, Carey PJ, Jackson GH et al (1990) An effective oral combination in advanced relapsed Hodgkin’s disease prednisolone, etoposide, chlorambucil and CCNU. Cancer Chemother Pharmacol 26:301–305

    Article  CAS  PubMed  Google Scholar 

  59. Böll B, Goergen H, Arndt N et al (2013) Relapsed Hodgkin lymphoma in older patients: a comprehensive analysis from the German Hodgkin study group. J Clin Oncol 31:4431–4437

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine I, University Hospital of Cologne, Kerpener Straße 62, Cologne, 50937, Germany

    Boris Böll

  2. Division of Hematology/Oncology, Tufts Medical Center, Tufts Cancer Center, 800 Washington Street, Boston, MA, 02111, USA

    Andrew M. Evens DO, MSc

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  1. Boris Böll
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  2. Andrew M. Evens DO, MSc
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Correspondence to Andrew M. Evens DO, MSc .

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Editors and Affiliations

  1. Universitätsklinikum Köln Klinik I für Innere Medizin, Köln, Germany

    Andreas Engert

  2. Memorial Sloan - Kettering Cancer Center, New York, New York, USA

    Anas Younes

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Böll, B., Evens, A.M. (2015). The Management of Older Patients with Hodgkin Lymphoma. In: Engert, A., Younes, A. (eds) Hodgkin Lymphoma. Hematologic Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-319-12505-3_15

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  • DOI: https://doi.org/10.1007/978-3-319-12505-3_15

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