How we treat elderly patients with Hodgkin lymphoma.

Purpose Of Review: To review Hodgkin lymphoma in older adults with regard to epidemiology, disease characteristics, prognosis, treatment, and future developments.

Recent Findings: Older Hodgkin lymphoma patients defined by chronological age represent a heterogeneous population in terms of life expectancy, morbidities, and functional status. Twenty-one percent of Swedish Hodgkin lymphoma patients are greater than 65 years (5%, >81 years) at diagnosis. In general, less than 10% of patients included in broad clinical trials are greater than 60 years. The proportion of mixed cellularity histopathology and EBV-genome-positive tumors is higher in older adults. Five-year relative survival of Swedish patients 66-80 and greater than 81 years is 0.58 and 0.26, respectively. Older patients have lower remission rates, but relapse-free survival is less impaired. No standard treatment recommendations exist. In older fit patients less than 65-70 years--go for 'young' treatment. Estimate thoroughly the individual patient's frailness/comorbidities in order to properly adjust treatment, thus saving patients from over/undertreatment. The use of early PET should be optimized in clinical practice. Representativeness of large clinical trials including evaluation of functional status and comorbidity remains crucial.

Summary: Elderly Hodgkin lymphoma patients still do poorly and improved prognostics, personalized and targeted treatment options associated with fewer side-effects will hopefully advance the clinical Hodgkin lymphoma field.