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Boris Böll, Bastian von Tresckow, Dennis A. Eichenauer, Stephanie Sasse, Michael Fuchs, Karolin Behringer, Beate C. Klimm, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Bastian von Tresckow, Dennis A. Eichenauer, Stephanie Sasse, Michael Fuchs, Karolin Behringer, Beate C. Klimm, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Nils Arndt and Ralph Naumann, Stiftungsklinikum Mittelrhein, Koblenz; Julia Meissner, Heidelberg University Hospital, Heidelberg; Stefan W. Krause, Erlangen University Hospital, Erlangen; and Roland Schnell, Pioh Medical Oncology and Hematology, Frechen, Germany.
Published: December 2013
AI Article Synopsis
Article Abstract
Purpose: Progression or relapse of Hodgkin lymphoma (HL) is common among older patients. However, prognosis and effects of second-line treatment are thus far unknown.
Patients And Methods: We investigated second-line treatment and survival in older patients with progressive or relapsed HL. Patients treated within German Hodgkin Study Group first-line studies between 1993 and 2007 were screened for refractory disease or relapse (RR-HL). Patients with RR-HL age ≥ 60 years at first-line treatment were included in this analysis.
Results: We identified 105 patients (median age, 66 years); 28%, 31%, and 41% had progressive disease, early relapse, or late relapse, respectively. Second-line treatment strategies included intensified salvage regimens (22%), conventional polychemotherapy and/or salvage-radiotherapy with curative intent (42%), and palliative approaches (31%). Median overall survival (OS) for the entire cohort was 12 months; OS at 3 years was 31% (95% CI, 22% to 40%). A prognostic score with risk factors (RFs) of early relapse, clinical stage III/IV, and anemia identified patients with favorable and unfavorable prognosis (≤ one RF: 3-year OS, 59%; 95% CI, 44% to 74%; ≥ two RFs: 3-year OS, 9%; 95% CI, 1% to 18%). In low-risk patients, the impact of therapy on survival was significant in favor of the conventional polychemotherapy/salvage radiotherapy approach. In high-risk patients, OS was low overall and did not differ significantly among treatment strategies.
Conclusion: OS in older patients with RR-HL can be predicted using a simple prognostic score. Poor outcome in high-risk patients cannot be overcome by any of the applied treatment strategies. Our results might help to guide treatment decisions and evaluate new compounds in these patients.
