Skip to main content
SpringerLink
Log in

Therapiestrategien für die Behandlung des Hodgkin-Lymphoms bei älteren Patienten

Therapy strategies for the treatment of Hodgkin’s lymphoma in elderly patients

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Ältere Patienten mit einem Hodgkin-Lymphom haben besonders in fortgeschrittenen Stadien unverändert eine relativ schlechte Prognose. Evidenzbasierte Therapieempfehlungen können wegen der sehr beschränkten Studienlage nicht gegeben werden. In der täglichen Praxis bei Patienten in frühen Stadien kann die Combined-Modality-Behandlung (2–4 Zyklen einer A(B)VD-Chemotherapie (Adriamycin, Bleomycin, Vinblastin, Dacarbazin, gefolgt von einer Involved-Field-Strahlentherapie), als etabliert gelten; bei Patienten in fortgeschrittenen Stadien erfolgen 6–8 Zyklen ABVD mit Radiatio nur der Restbefunde. Aggressivere Chemotherapie ist aufgrund der Komorbiditäten in diesem Patientenkollektiv und der eingeschränkten Tolerabilität der Chemotherapie oftmals nicht durchführbar. Daher ist das Ziel der aktuellen klinischen Forschung weiterhin die Entwicklung einer Behandlung mit hoher Effektivität bei reduzierter Toxizität. Hierfür müssen vorliegende Begleiterkrankungen, innovative Therapieansätze, aber auch die Lebensqualität während und nach der Therapie bereits in die Studienplanung einbezogen werden. Die GHSG (German Hodgkin Lymphoma Study Group) hat deshalb aktuell eine Phase-I/II-Studie initiiert, in der Bleomycin im ABVD-Schema durch die immunmodulatorische Substanz Lenalidomid ersetzt wird.

Abstract

Elderly patients with Hodgkin’s lymphoma still have a relative poor prognosis especially in advanced stages. Due to the lack of large randomized studies, no evidence-based standard treatment can be defined. In routine practice patients with early stages disease are treated with a combined modality strategy of 2–4 cycles A(B)VD (adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy followed by involved-field radiation therapy. Patients with advanced stage disease are usually treated with 6–8 cycles of A(B)VD followed by radiotherapy to residual disease. A more aggressive regimen would be preferable but is frequently not feasible in this patient cohort due to comorbidities. Therefore, the aim of future studies is still to develop regimens with high anti-tumor efficacy but low toxicity. These studies require an elderly-specific design that takes comorbidities, innovative treatment approaches and quality of life issues during therapy and follow-up into account. Therefore, the GHSG (German Hodgkin Lymphoma Study Group) has initiated a phase I/II study to investigate the new immunomodulatory drug lenalidomide in combination with AVD in elderly patients with early unfavorable or advanced stage disease.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  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 20:2988–1994

    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

    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, Sundstrom 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. 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 

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

    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

    PubMed  Google Scholar 

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

  13. 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 

  14. 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)

    Article  CAS  Google Scholar 

  15. 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 

  16. 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 

  17. 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 

  18. 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 

  19. Spronsen DJ van, 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 

  20. 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 

  21. 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 

  22. 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 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  25. 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 

  26. Enblad G, Gustavsson A, Sundstrom 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 

  27. 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 

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

    Google Scholar 

  29. 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 

  30. 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 

  31. Brusamolino E, Bacigalupo A, Barosi G et al (2009) Classical Hodgkin’s lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up. Haematologica 94:550–565

    Article  PubMed  Google Scholar 

  32. Repetto L, Biganzoli L, Koehne CH et al (2003) EORTC Cancer in the Elderly Task Force guidelines for the use of colony-stimulating factors in elderly patients with cancer. Eur J Cancer 39:2264–2272

    Article  CAS  PubMed  Google Scholar 

  33. Doorduijn JK, Holt B van der, Imhoff GW van et al (2003) CHOP compared with CHOP plus granulocyte colony-stimulating factor in elderly patients with aggressive non-Hodgkin’s lymphoma. J Clin Oncol 21:3041–3050

    Article  CAS  PubMed  Google Scholar 

  34. Bohlius J, Reiser M, Schwarzer G et al (2003) Impact of granulocyte colony-stimulating factor (CSF) and granulocyte-macrophage CSF in patients with malignant lymphoma: a systematic review. Br J Haematol 122:413–423

    Article  CAS  PubMed  Google Scholar 

  35. Smith TJ, Khatcheressian J, Lyman GH et al (2006) 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 24:3187–3205

    Article  CAS  PubMed  Google Scholar 

  36. 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 

  37. 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 

  38. 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 

  39. Mueller H, Nogova L, Eichenauer DA et al (2008) The Newly Developed Modified BEACOPP-Regimen (BACOPP) Is Active and Feasible in Elderly Patients with Hodgkin Lymphoma: Results of a Phase II Study of the German Hodgkin Study Group (GHSG). Blood 112:Abstract 2600

    Google Scholar 

  40. 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 63–67

  41. Proctor SJ, Wilkinson J (2007) A web-based study concept designed to progress clinical research for ‚orphan‘ disease areas in haematological oncology in the elderly: the SHIELD programme. Crit Rev Oncol Hematol 61:79–83

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. German Hodgkin Study Group (GHSG), Köln, Deutschland

    T. Halbsguth &  P. Borchmann

  2. Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    T. Halbsguth &  P. Borchmann

Authors
  1. T. Halbsguth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Borchmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Borchmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Halbsguth, T., Borchmann, P. Therapiestrategien für die Behandlung des Hodgkin-Lymphoms bei älteren Patienten. Onkologe 16, 55–62 (2010). https://doi.org/10.1007/s00761-009-1766-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-009-1766-1

Schlüsselwörter

Keywords

Search

Navigation