136 Hodgkin's disease in the elderly patients (60 or older): Clinical outcome and treatment strategies

9035 Background: To assess clinical outcome of chemotherapy and involved field radiotherapy in all stages of pediatric Hodgkin’s Disease in rural areas of Egypt treated at Menya oncology centre which is located 300km south the capital. Methods: Between April 2000 and November 2005, 27 previously untreated patients were investigated, treated and analyzed for remission and survival. Results: There were 21 males and 6 girls with a median age of 11 years, 29.6% were less than 10 years, 70.3% had advanced stage disease (IIB-IV), bulky mediastinal mass in 19 cases spleen involvement in 6 cases, bone marrow aspirate was free in all cases, bone marrow biopsy was not done. patients with stage I and IIA received 2 courses of EOPA (etopsid, vincristine, prednisone and doxorubicin), patients with stage IIb and IIIa received 2 courses of EOPA and 2 courses of ECOP (etopsid, cyclophophamide, vincristine and prednisone), while patients with stage IIIb and IV received 2courses of EOPA and 4 courses of ECOP, All patients received involved field radiotherapy according to stage. Complete remission was achieved in 96.2%. Progressive disease in 1 (3.7%) which required change line of therapy. Out of the 27 patients 3 (11.1%) have relapsed (17, 22 and 25 months) post completion of chemotherapy and were treated with another line of chemotherapy. The 2 years DFS was 90.9% with 95% of CI (73%-100%). Treatment was given outpatient, with no supportive therapy or toxic deaths and no secondary malignancy from etopsid Conclusions: This regimen provides high rate of durable remission in rural areas of Egypt with limited resources (drugs availability and supportive measures). No significant financial relationships to disclose.

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Metastatic melanoma in the elderly: Case series of clinical outcome and immune characteristics

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20018 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20018-e20018

Author(s):

U. P. Hegde ◽

N. Chakraborty ◽

A. Chhabra ◽

S. Ray

Keyword(s):

Immune System ◽

Clinical Outcome ◽

Elderly Patients ◽

Metastatic Melanoma ◽

Cutaneous Melanoma ◽

Proliferative Activity ◽

The Elderly ◽

High Dose ◽

The Impact

e20018 Background: Cutaneous melanoma incidence is rapidly rising in the elderly population. Imbalances of the immune system are described due to aging associated changes between CD4+, CD8+, T helper (Th) 1, Th 2 and T regulatory and T effector lymphocytes (lym). We describe clinical outcome in 10 elderly patients (pts) with cutaneous metastatic melanoma (CMM) and results of the immune studies done in a subgroup. Methods: Between October 2002 and October 2008, 10 elderly pts with treatment naïve CMM, 6 males and 4 female, median ages 76, range 57–84 years were treated at the University of Connecticut Health Center. Metastatic sites included soft tissue in 2 patients (pts), lung and/or liver with lymph node (LN) involvement (6 pts) and distant LN metastasis (2pts). Eight pts opted for treatment and received single or combination chemotherapy (5pts), high dose Interleukin 2 (2 pts), complete tumor resection followed by tumor derived heat shock protein vaccine (1 pt on clinical trial) and bio chemotherapy (1pt). One patient declined treatment (included in follow up). In vitro immune characteristics were studied in HLA-A2 positive subgroup (5pts) and included cytotoxic T lym (CTL) generation against self and non self peptides (Mart-1 27–35 and influenza MP derived peptide flu 58–66), proliferative activity of CD4+ lym in response to anti CD3 antibody under Th1 and Th2 conditions and regulatory T lym activity of CD4+CD25+ lym against CTL. Results: All patients tolerated treatments well resulting in 1 complete response, 4 partial responses, and 4 stable diseases. During 6 year follow up period, 6 patients died while 4 patients are living (one with disease). The median survival of all patients is 28.1 month (mo) while in those surviving (4pts) is 72 mo. Immune studies revealed preserved proliferative activity of CD4+ lym with stronger Th1 induction than Th2. The CTL responses to self and non self antigens were preserved while regulatory T lym showed weak activity against CTL. Conclusions: Some elderly patients with metastatic melanoma demonstrate improved outcomes and favorable immune characteristics. Further studies are needed to understand the impact of aging immune system on cutaneous melanoma. No significant financial relationships to disclose.

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Hodgkin's disease in the elderly: A single institution retrospective study of 40 patients aged 65 or over

Haematologia ◽

10.1163/156855900300109512 ◽

2000 ◽

Vol 30 (4) ◽

pp. 263-269 ◽

Cited By ~ 1

Author(s):

Árpád Illés ◽

Györgyi Vadász ◽

Lajos Gergely ◽

Gyula Szegedi

Keyword(s):

Retrospective Study ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

The Elderly ◽

Single Institution

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IXB.3 Hodgkin's disease in elderly patients

Critical Reviews in Oncology/Hematology ◽

10.1016/s1040-8428(13)70159-8 ◽

2007 ◽

Vol 64 ◽

pp. S28

Author(s):

J. Gómez Codina

Keyword(s):

Elderly Patients ◽

Hodgkin's Disease ◽

Hodgkin’S Disease

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HODGKIN'S DISEASE IN THE ELDERLY

The Lancet ◽

10.1016/s0140-6736(73)92167-3 ◽

1973 ◽

Vol 301 (7806) ◽

pp. 774 ◽

Cited By ~ 3

Author(s):

FrederickP. Li ◽

Jacob Lokich ◽

Mary Costanza ◽

WilliamC. Moloney ◽

Samuel Hellman

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

The Elderly

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COP-BLAM Therapy for a Hodgkin's Disease in the Elderly.

Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics ◽

10.3143/geriatrics.36.412 ◽

1999 ◽

Vol 36 (6) ◽

pp. 412-415

Author(s):

Nozomi Niitsu ◽

Michihiro Nakayama ◽

Masanori Umeda

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

The Elderly

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Decision Analysis on Alternative Treatment Strategies for Favorable-Prognosis, Early-Stage Hodgkin's Disease

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.11.3577 ◽

1999 ◽

Vol 17 (11) ◽

pp. 3577-3585 ◽

Cited By ~ 20

Author(s):

Andrea K. Ng ◽

Jane C. Weeks ◽

Peter M. Mauch ◽

Karen M. Kuntz

Keyword(s):

Sensitivity Analysis ◽

Life Expectancy ◽

Decision Analysis ◽

Hodgkin's Disease ◽

Early Stage ◽

Hodgkin’S Disease ◽

Treatment Strategies ◽

Favorable Prognosis ◽

Ps I ◽

Study Results

PURPOSE: To compare the therapeutic outcomes of various treatment strategies in early-stage, favorable-prognosis Hodgkin's disease (HD) using methods of decision analysis. METHODS: We constructed a decision-analytic model to determine the life expectancy and quality-adjusted life expectancy for a hypothetical cohort of clinically or pathologically staged 25-year-old patients with early-stage, favorable-prognosis HD treated with varying degrees of initial therapy. Markov models were used to simulate the lifetime clinical course of patients, and baseline probability estimates were derived from published study results. RESULTS: Among patients with pathologic stage (PS) I to II, mantle and para-aortic (MPA) radiotherapy was favored over combined-modality therapy (CMT), mantle radiotherapy, and chemotherapy by 1.18, 1.33, and 1.55 years, respectively. For patients with clinical stage (CS) I to II, the treatment options of MPA-splenic radiotherapy, CMT, and chemotherapy yielded similar survival outcomes. Sensitivity analysis showed that the decision between CMT and MPA-splenic radiotherapy was highly influenced by the precise values of the estimates of treatment efficacy and long-term morbidity, the quality-of-life value assigned to the postsplenic irradiation state, and the time discount value used in the model. Probabilistic sensitivity analysis demonstrated that even if future studies doubled the precision of the estimates of the treatment-related variables, it would be impossible to demonstrate the superiority of one treatment over the other. CONCLUSION: Our model predicted that on average, MPA radiotherapy was clearly the preferred treatment for PS I to II patients. For CS I to II patients the treatment decision is a toss-up between MPA-splenic radiotherapy and CMT, emphasizing the importance of patient preference exploration and shared decision making between patient and physician when choosing between treatments.

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