Hodgkin’s lymphoma in the elderly veterans: We need to do better

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17554-17554
Author(s):  
M. H. Al Sayyed ◽  
S. F. Maken ◽  
M. M. Safa ◽  
Z. A. Nahleh ◽  
J. R. Pancoast ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hodgkin’S Lymphoma ◽  
Young Patients ◽  
The Elderly ◽  
Hodgkin's Lymphoma ◽  
P Value ◽  
Bulky Disease ◽  
Cancer Data ◽  
Veteran Affairs ◽  
Medical Centers

17554 Background: Recent studies demonstrated worse outcome in elderly patients diagnosed with Hodgkin’s Lymphoma (HL). The purpose of this study was to compare the presenting features, treatment, and outcome of elderly patients with HL within the Veteran Affairs Health care system (VA). Methods: This was a retrospective analysis. The VA Central Cancer Registry (VACCR) database was used to identify patients with HL diagnosed between 1995 and 2005. There are approximately 120 VA medical centers diagnosing and/or treating patients with cancer. Data are entered by tumor registrars at the VA medical centers. This site aggregates the data collected by the medical centers’ cancer registries. Data was extrapolated and analyzed using bio-statistical software SPSS. Results: We analyzed 1009 patients in the Veteran Affairs (VA) database with the diagnosis of Hodgkin’s lymphoma. Patients were divided into two groups according to age, elderly group (> 60 years) (n = 383) and young group (Age ≤ 60 years) (n = 626). The median age of presentation in elderly patients was 70 years; the most common stage at diagnosis was Stage IV. The most common histological subtype was nodular sclerosis and bulky disease was present in 89 (23.2%) of patients. Out of 383 patients 237 (62%) were treated with chemotherapy, 88 patients (23%) received radiation. Compared to patients ≤ 60 years of age, elderly patients were less likely to be current smokers, more likely to be caucasian, all other baseline characteristics were not statistically significantly different. Less elderly patients received chemotherapy compared to young patients (62% versus 74%) (P-value 0.004). No difference was observed in radiation therapy. The 5 year Overall survival in the elderly was 27 % compared to 70% in patients aged 60 or less. (P-value <0.005). Conclusions: Outcome of HL among elderly veterans is poor. Elderly patients received less chemotherapy treatment. Novel strategies to better deliver treatment in elderly patients with HL are warranted. No significant financial relationships to disclose.

Hodgkin’s lymphoma among veterans: Does race matter?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17538-17538
Author(s):  
R. S. Komrokji ◽  
S. F. Mekan ◽  
M. M. Safa ◽  
Z. A. Nahleh ◽  
J. R. Pancoast ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Similar Proportion ◽  
P Value ◽  
Bulky Disease ◽  
Cancer Data ◽  
Medical Centers ◽  
Black Patients ◽  
History Of ◽  
White Patients

17538 Background: Racial disparities in Hodgkin’s lymphoma (HL) are not well studied. Earlier studies suggested that black patients received less treatment and had worse outcome. The VA health care system offers a platform to study those racial differences given similar other variables and socioeconomic status among those patients. Methods: This was a retrospective analysis. The VA Central Cancer Registry (VACCR) database was used to identify patients with HL diagnosed between 1995 and 2005. There are approximately 120 VA medical centers diagnosing and/or treating patients with cancer. Data are entered by tumor registrars at the VA medical centers. This site aggregates the data collected by the medical centers’ cancer registries. Data was extrapolated and analyzed using bio-statistical software SPSS. Results: There were 1009 patients with HL at the VA system, 801 white and 183 black patients. Twenty-five patients from other racial groups were excluded from this analysis. The median age of presentation among blacks was 50.8 years compared to 53.8 years among whites (P-value 0.026). More white patients had family history of HL. Black patients had a higher incidence lymphocyte depleted histological subtype 33 (18.0%) vs. 75 (9.4%) and whites had a higher prevalence of nodular sclerosing subtype, 260 (32.5%) vs. 32 (17.5%). Other baseline characteristics such as sex, history of smoking, alcohol, and radiation exposure were similar. Presence of bulky disease and stage of lymphoma at presentation were also similar. Similar proportion of patients received chemotherapy among the two groups, 70 % for blacks and 69% for whites. Among blacks 19.7 % of patients received radiation while 25.5 % white patients did (P-value 0.24). The 5-year overall survival of blacks was 53 % years as opposed to 54% for whites (P-value 0.93) Conclusions: The presenting features, risk factors are similar across black and white races among VA population. Blacks are more likely to present with lymphocyte depleted type of HD. The treatment and outcome of HL among blacks are not different from whites within the VA system. No significant financial relationships to disclose.

Non-Hodgkin's Lymphoma in the Elderly: A Retrospective Evaluation of Toxicity Related to Aggressive vs. Conservative Treatments

1988 ◽  
Vol 74 (4) ◽  
pp. 433-438 ◽  
Author(s):  
Umberto Tirelli ◽  
Vittorina Zagonel ◽  
Rachele Volpe ◽  
Mauro G. Trovo ◽  
Antonino Carbone
Keyword(s):  
Elderly Patients ◽  
Hodgkin’S Lymphoma ◽  
Randomized Trials ◽  
Survival Rates ◽  
The Elderly ◽  
Hodgkin's Lymphoma ◽  
Severe Toxicity ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Significant Difference

The outcome of 70 elderly patients aged 65 years or more (median, 71 years) with non-Hodgkin's lymphoma (NHL) treated between 1973 and 1981 with aggressive (AM) or conservative modalities (CM) was retrospectively evaluated. A significantly higher incidence of lethal and severe toxicity was observed in patients treated with AM than in those treated with CM (32 % vs 3 %, p < 0.01), with 10 % treatment related deaths in the AM group. Only 56 % of the deaths were attributed to NHL; other major causes were treatment-related deaths, infection and cardiac diseases. No significant difference in response and survival was found between AM and CM groups (complete remission rates were 35 % vs 42 %, and 10 year survival rates were 31 % vs 19 %, respectively), but the prevalence of stages III-IV in patients treated with AM makes these results meaningless. Prospective randomized trials with AM vs CM are clearly needed in elderly patients with advanced unfavorable NHL.

Hodgkin's Lymphoma in Elderly Patients: A Comprehensive Retrospective Analysis From the German Hodgkin's Study Group

2005 ◽  
Vol 23 (22) ◽  
pp. 5052-5060 ◽  
Author(s):  
Andreas Engert ◽  
Veronika Ballova ◽  
Heinz Haverkamp ◽  
Beate Pfistner ◽  
Andreas Josting ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Retrospective Analysis ◽  
Hodgkin’S Lymphoma ◽  
Performance Status ◽  
Dose Intensity ◽  
Risk Groups ◽  
Hodgkin's Lymphoma ◽  
Study Group ◽  
Bulky Disease ◽  
Subtype B

Purpose With improved prognosis for patients with Hodgkin's lymphoma (HL), interest increasingly focuses on high-risk groups such as elderly patients. We thus performed a retrospective analysis using the German Hodgkin's Study Group (GHSG) database to determine clinical risk factors, course of treatment, and outcome in elderly HL patients in comparison with younger adults. Patients and Methods A total of 4,251 patients included in the GHSG studies HD5 to HD9 were analyzed, of whom 372 (8.8%) were 60 years or older and 3,879 (91.2%) were younger than 60 years. Patient characteristics, treatment results, toxicity, freedom from treatment failure (FFTF), and overall survival (OS) were compared. Results Elderly patients more often had mixed cellularity subtype, “B” symptoms, elevated erythrocyte sedimentation rate, and poorer performance status. Less frequently observed were nodular sclerosis subtype, large mediastinal mass, and bulky disease. Acute toxicity during chemotherapy was generally higher in elderly patients. This was most obvious for severe infections (grade 3 or 4; 15% v 6%) correlating with more severe leukopenia in elderly patients (grade 4; 38% v 23%). As a result, significantly fewer elderly patients received the intended full chemotherapy dose (75% v 91%). The survival analysis showed a significantly poorer treatment outcome for elderly patients in terms of 5-year OS (65% v 90%), FFTF (60% v 80%), and HL-specific FFTF (73% v 82%). Conclusion Elderly patients have a poorer risk profile compared with younger HL patients and experience more severe treatment-associated toxicity. Higher mortality during treatment as well as lower dose-intensity are the major factors explaining the poorer overall outcome of elderly HL patients.

Risk factors for treatment-related death in elderly patients with aggressive non-Hodgkin's lymphoma: results of a multivariate analysis.

1998 ◽  
Vol 16 (6) ◽  
pp. 2065-2069 ◽  
Author(s):  
H Gómez ◽  
M Hidalgo ◽  
L Casanova ◽  
R Colomer ◽  
D L Pen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hodgkin’S Lymphoma ◽  
Performance Status ◽  
Hodgkin's Lymphoma ◽  
Serum Lactate Dehydrogenase ◽  
High Grade ◽  
Chop Chemotherapy ◽  
Bulky Disease ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

PURPOSE It has been suggested that age is associated with chemotherapy-related death in patients with non-Hodgkin's lymphoma (NHL) treated with doxorubicin-containing chemotherapy. The purpose of this study was to evaluate the relative influence of increasing age and other clinical parameters on the occurrence of treatment-related death in elderly patients with intermediate- or high-grade NHL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. METHODS A retrospective study of patients 60 years of age or older with intermediate- or high-grade NHL treated with CHOP chemotherapy in a single cancer center. The following variables were recorded: age (60 to 69, 70 to 79, and 80 to 94 years), histology (Working Formulation [WF] D, E, F, G, and H), Ann Arbor stage, B symptoms, extranodal involvement, bulky disease (> 7 cm), performance status (Eastern Cooperative Oncology Group [ECOG] scale), International Prognostic Index (IPI score), serum lactate dehydrogenase (LDH) level and doxorubicin relative dose-intensity (RDI). The relationship between these features and treatment-related death was assessed in univariate and multivariate logistic regression analysis. RESULTS From 1982 to 1991, 267 consecutive patients were treated. Median age was 70 years (range, 60 to 94 years). There were 35 toxic deaths. Sixty-three percent of the deaths occurred after the first cycle. Infection accounted for 82% of the toxic deaths. In the univariate analysis, the features associated with an increased risk of toxic death were ECOG performance status 2 to 4 (relative risk [RR], 7.82), B symptoms (RR, 3.38), diffuse large-cell histology (RR, 3.06), bulky disease (RR, 2.58), serum levels of LDH (RR, 2.53), and IPI score (RR, 2.46). The age groups did not show significance. In the regression model, performance status 2 to 4 was the only independent predictor of treatment-related death (RR, 3.52; 95% confidence interval [CI], 2.98 to 4.06). CONCLUSION Our results show that in elderly patients with NHL treated with doxorubicin-based chemotherapy the risk for treatment-related death is associated with poor performance status rather than with increasing chronologic age.

scholarly journals High-dose chemotherapy and auto-SCT in elderly patients with Hodgkin's lymphoma

2011 ◽  
Vol 46 (10) ◽  
pp. 1339-1344 ◽  
Author(s):  
N Puig ◽  
M Pintilie ◽  
T Seshadri ◽  
K al-Farsi ◽  
N Franke ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hodgkin’S Lymphoma ◽  
High Dose Chemotherapy ◽  
Hodgkin's Lymphoma ◽  
High Dose

Prognostic and predictive factors in early stages of classic Hodgkin’s lymphoma

2022 ◽  
pp. 7-15
Author(s):  
T. I. Bogatyreva ◽  
A. O. Afanasov ◽  
A. Yu. Terekhova ◽  
N. A. Falaleeva
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Hodgkin's Lymphoma ◽  
Cure Rate ◽  
First Line ◽  
Bulky Disease ◽  
Cox Regression Analysis ◽  
Early Stages

Rationale. In the early stages of classical Hodgkin’s lymphoma (cHL), the cure rate reaches 85–95 %, but the long-term effects of therapy can worsen overall survival. Current trials for early stages of Hodgkin’s lymphoma with favorable prognosis address the task of maintaining cure rates while reducing sequelae. For early unfavorable stages, the challenge is to improve cure rate without increasing toxicity.Purpose. To assess the potential significance of individual risk factors for optimal choice of the first line chemotherapy in early-stage Hodgkin lymphoma.Materials and methods. This single-center retrospective study included 290 patients with early stage cHL who had received ABVD – based (n = 249; 86 %) or BEACOPP‑21 – based (n = 41; 14 %) combined modality therapy from 2000 to 2017. Progression-free survival (PFS) and overall survival (OS) were assessed in Cox regression analysis including 12 clinical parameters.Main results. At a median follow up of 60 months for the entire group, OS was 95 % and PFS was 89 %. In a multivariate analysis PFS, at 5 years, was significantly inferior in patients with mediastinal bulk, baseline lymphocytopenia (≤ 0.6 × 109/L, р = 0.002; < 1.0 × 109/L, р = 0.000) and male gender; OS was inferior only in patients with an absolute lymphocytopenia (AL). In patients with AL, PFS after ABVD-based regimen was, respectively, 12 % in the high-risk group with mediastinal bulk and 56 % without it. PFS of patients without AL when treated with ABVD did not differ compared to BEACOPP‑21 within the same prognostic group: 95.2 % vs. 92.3 % for non-bulky and 86.4 % vs. 84.2 % for bulky disease. In the absence of AL, mediastinal bulk remained the main and only risk factor in multivariate analysis.Conclusions. The ABVD regimen is highly effective in the first line of chemotherapy for cHL, except for cases with baseline lymphocytopenia, in which the early usage of the BEACOPP regimen in the escalated or 14-day variants might be justified. In patients with mediastinal bulk, standard chemotherapy is not effective enough even in the absence of AL; therefore, if an intermediate PET/CT scan is available, it seems more appropriate to use a milder ABVD regimen on the first line and leave intensive therapy for patients with proven refractory disease. Prospects for improving the efficiency are opened with the new N-AVD and A-AVD schemes, the benefits of which should be evaluated, first of all, in patients with AL and mediastinal bulk.

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