TY - JOUR
T1 - Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma
AU - Orellana-Noia, Victor M.
AU - Isaac, Krista
AU - Malecek, Mary Kate
AU - Bartlett, Nancy L.
AU - Voorhees, Timothy J.
AU - Grover, Natalie S.
AU - Hwang, Steven R.
AU - Nora Bennani, N.
AU - Hu, Rachel
AU - Hill, Brian T.
AU - Mou, Eric
AU - Advani, Ranjana H.
AU - Carter, Jordan
AU - David, Kevin A.
AU - Ballard, Hatcher J.
AU - Svoboda, Jakub
AU - Churnetski, Michael C.
AU - Magarelli, Gabriela
AU - Feldman, Tatyana A.
AU - Cohen, Jonathon B.
AU - Evens, Andrew M.
AU - Portell, Craig A.
N1 - Funding Information:
This study originated at the University of Virginia, with support from the University of Virginia Cancer Center (P30CA044579) (C.A.P.). Research reported in this publication was supported by the National Cancer Institute, National Institutes of Health (NIH), under award K12CA237806 from the Winship K12 Clinical Oncology Training Program (V.M.-O.) and by the National Center for Advancing Translational Sciences, NIH, under award UL1TR002378 from the Georgia Clinical and Translational Science Alliance (V.M.-O.).
Publisher Copyright:
© 2021 by The American Society of Hematology.
PY - 2021/9/28
Y1 - 2021/9/28
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85116147941&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2021004645
DO - 10.1182/bloodadvances.2021004645
M3 - Article
C2 - 34448831
AN - SCOPUS:85116147941
SN - 2473-9529
VL - 5
SP - 2623
EP - 3632
JO - Blood advances
JF - Blood advances
IS - 18
ER -