Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma

Victor M. Orellana-Noia, Krista Isaac, Mary Kate Malecek, Nancy L. Bartlett, Timothy J. Voorhees, Natalie S. Grover, Steven R. Hwang, N. Nora Bennani, Rachel Hu, Brian T. Hill, Eric Mou, Ranjana H. Advani, Jordan Carter, Kevin A. David, Hatcher J. Ballard, Jakub Svoboda, Michael C. Churnetski, Gabriela Magarelli, Tatyana A. Feldman, Jonathon B. CohenAndrew M. Evens, Craig A. Portell

Research output: Contribution to journalArticlepeer-review

Abstract

We performed a multicenter retrospective analysis across 10 US academic medical centers to evaluate treatment patterns and outcomes in patients age $60 years with classic Hodgkin lymphoma (cHL) from 2010-2018. Among 244 eligible patients, median age was 68, 63% had advanced stage (III/IV), 96% had Eastern Cooperative Oncology Group performance status (PS) 0-2, and 12% had documented loss of $1 activity of daily living (ADL). Medical comorbidities were assessed by the Cumulative Illness Rating Scale–Geriatric (CIRS-G), where n 5 44 (18%) had total scores $10. Using multivariable Cox models, only ADL loss predicted shorter progression-free (PFS; hazard ratio [HR] 2.13, P 5 .007) and overall survival (OS; HR 2.52, P 5 .02). Most patients (n 5 203, 83%) received conventional chemotherapy regimens, including doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD; 56%), AVD (14%), and AVD with brentuximab vedotin (BV; 9%). Compared to alternative therapies, conventional regimens significantly improved PFS (HR 0.46, P 5 .0007) and OS (HR 0.31, P 5 .0003). Survival was similar following conventional chemotherapy in those ages 60-69 vs $70: PFS HR 0.88, P 5 .63; OS HR 0.73, P 5 .55. Early treatment discontinuation due to toxicity was more common with CIRS-G $10 (28% vs 12%, P 5 .016) or documented geriatric syndrome (28% vs 13%, P 5 .02). A competing risk analysis demonstrated improved disease-related survival with conventional therapy (HR 0.29, P 5 .02) and higher mortality from causes other than disease or treatment with high CIRS-G or geriatric syndromes. This study suggests conventional chemotherapy regimens remain a standard of care in fit older patients with cHL, and highlights the importance of geriatric assessments in defining fitness for cHL therapy going forward.

Original languageEnglish
Pages (from-to)2623-3632
Number of pages1010
JournalBlood Advances
Volume5
Issue number18
DOIs
StatePublished - Sep 28 2021

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