Correlation between intensity of treatment plan and prognosis in elderly patients with Hodgkin's lymphoma

Hodgkin's lymphoma (HL) is an aggressive malignant hematological disease with a high incidence in adolescents and elderly (70-80 years old) people
.

Young HL patients have a higher cure rate, with a 5-year overall survival (OS) rate of more than 85%, while elderly HL patients have a poor prognosis, with a 5-year OS rate of less than 60%
.

The poor prognosis of elderly HL patients may be related to biological factors, treatment-related toxic and side effects, and active treatment intentions
.

At present, the first-line treatment for HL patients, especially young HL patients, is mainly multi-drug chemotherapy, such as ABVD or enhanced BEACOPP, with or without radiotherapy
.

The number of cycles of chemotherapy regimens varies with the disease stage, early treatment remission, and tolerance to chemotherapy in HL patients
.

Elderly HL patients, especially those with comorbidities, may not be able to tolerate multi-drug chemotherapy, and are usually treated with reduced-dose chemotherapy or palliative therapy
.

 Although the survival rate of elderly HL patients is worse than that of young HL patients, elderly HL patients still have the opportunity to improve the prognosis through appropriate treatment
.

However, the current HL-related research rarely explores the relationship between the intensity of the treatment plan and the patient's prognosis
.

A retrospective cohort study used the SEER-Medicare database to explore the relationship between the intensity of treatment options and the cause-specific mortality of elderly HL patients
.

The main results of the research are summarized as follows for the reference of readers
.

Research methods This cohort study included patients who were diagnosed with HL from 1999 to 2016 in the SEER-Medicare database and were ≥65 years of age at the time of diagnosis
.

Inclusion of HL patients requires at least 3 years of follow-up to obtain 3-year survival data
.

The basic situation of the study results The study included a total of 2686 HL patients, with an average age of 75.
7 years, of which 1333 (50%) patients were men
.

1307 (49%) patients had early HL, and 1379 (51%) patients had late HL
.

The geographical characteristics of patients at different disease stages are similar, but there are some differences in disease characteristics and treatment conditions of patients at different disease stages
.

Compared with the 2686 patients included in the analysis, the 317 patients excluded from the analysis were older (79.
0 years old vs 75.
7 years old), had a higher degree of frailty (weakness score: 26.
5 points vs.
15.
3 points), and had better comorbidities.
Poor (complication score: 3 points vs 1.
8 points), disease stage is late (stage IV HL patients: 140 cases [44%] vs 632 cases [24%])
.

The relationship between early HL treatment regimen and specific cause mortality After 3 years of treatment, 228 patients died of HL, 281 patients died of other causes, and 798 patients survived
.

Compared with elderly HL patients receiving normal intensity regimens, elderly patients receiving reduced intensity regimens (HR: 1.
77; 95%CI: 1.
22-2.
57) or no treatment (HR: 1.
91; 95%CI: 1.
31-2.
79) HL patients have a higher risk of death due to HL, while elderly HL patients receiving single-drug regimen or radiotherapy have no difference in risk of death due to HL and elderly HL patients receiving multi-drug combination regimen (HR: 1.
37; 95% CI: 0.
92- 2.
06)
.

Compared with elderly patients with HL who received normal intensity regimens, elderly patients who received reduced intensity regimens (HR: 1.
69; 95%CI: 1.
18-2.
44) or no treatment (HR: 2.
71; 95%CI: 1.
95-3.
78) Patients with HL are also at higher risk of death from other causes
.

The relationship between treatment regimens and specific cause mortality in patients with advanced HL After 3 years of treatment, 357 patients died of HL, 380 patients died of other causes, and 624 patients survived
.

Compared with elderly HL patients who received normal intensity regimens, they received reduced intensity regimens (HR: 3.
26; 95%CI: 2.
44-4.
35), single-drug regimens or radiotherapy (HR: 2.
85; 95%CI: 1.
98- 4.
11) Elderly HL patients who do not receive treatment (HR: 4.
06; 95%CI: 3.
06-5.
37) are at higher risk of death due to HL
.

Compared with elderly HL patients who received normal intensity regimens, they received reduced intensity regimens (HR: 1.
76; 95%CI: 1.
32-2.
33), single-drug regimens or radiotherapy (HR: 1.
65; 95%CI: 1.
15- 2.
37) Elderly HL patients who do not receive treatment (HR: 2.
24; 95% CI: 1.
71-2.
94) are also at higher risk of death due to other causes
.

Research conclusions The study showed that the relationship between the intensity of treatment options and the mortality of HL patients differs depending on the stage and the cause of the HL disease
.

Elderly HL patients who can tolerate normal-intensity chemotherapy regimens can obtain a better prognosis
.

Clinically, it is necessary to choose an appropriate treatment plan according to the age, weakness, comorbidities, and treatment preferences of elderly HL patients, so as to bring better prognosis for elderly HL patients
.

Reference: Angie Mae Rodday, Theresa Hahn, AnitaJ.
Kumar, et al.
Association of Treatment Intensity With Survival in Older Patients With Hodgkin Lymphoma.
JAMA NetwOpen.
2021; 4(10): e2128373.
Stamp "read the original text", let's work together progress