Skip to main content

Advertisement

Springer Nature Link
Log in

The Unique Characteristics and Management of Patients Over 60 Years of Age with Classic Hodgkin Lymphoma

  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

In recent decades, the prognosis of Hodgkin lymphoma has been substantially improved, but these successes have been restricted to younger patients and could not be translated into a major benefit for older patients, especially those with advanced-stage disease. Major problems in treating older patients include a different biology, frailty, comorbidities, and poorer tolerance of therapy. Additionally, these patients are often excluded from randomized trials, so an evidence-based standard of care is lacking. Importantly, the proportion of older patients with HL will increase over the next 50 years. Currently, ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, and dacarbazine) is considered to be the gold standard, even though it has some toxicity in older patients and prospective data are not available. Thus, further studies are required, including the assessment of comorbidities and the incorporation of new drugs such as immunomodulatory agents, antibody-drug conjugates, mTOR inhibitors, or histone deacetylase (HDAC) inhibitors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

Papers of particular interests, published recently, have been highlighted as: • Of importance

  1. Diehl V, Franklin J, Pfreundschuh M, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. N Engl J Med. 2003;348:2386–95.

    Article  PubMed  CAS  Google Scholar 

  2. Horning SJ, Hoppe RT, Breslin S, et al. Stanford V and radiotherapy for locally extensive and advanced Hodgkin’s disease: mature results of a prospective clinical trial. J Clin Oncol. 2002;20:630–7.

    Article  PubMed  Google Scholar 

  3. Radford JA, Rohatiner AZ, Ryder WD, et al. ChlVPP/EVA hybrid versus the weekly VAPEC-B regimen for previously untreated Hodgkin’s disease. J Clin Oncol. 2002;20:2988–94.

    Article  PubMed  CAS  Google Scholar 

  4. Austin-Seymour MM, Hoppe RT, Cox RS, et al. Hodgkin’s disease in patients over sixty years old. Ann Intern Med. 1984;100:13–8.

    PubMed  CAS  Google Scholar 

  5. Engert A, Ballova V, Haverkamp H, et al. Hodgkin’s lymphoma in elderly patients: a comprehensive retrospective analysis from the German Hodgkin’s Study Group. J Clin Oncol. 2005;23:5052–60.

    Article  PubMed  Google Scholar 

  6. Erdkamp FL, Breed WP, Bosch LJ, et al. Hodgkin disease in the elderly. A registry-based analysis. Cancer. 1992;70:830–4.

    Article  PubMed  CAS  Google Scholar 

  7. Weekes CD, Vose JM, Lynch JC, et al. Hodgkin’s disease in the elderly: improved treatment outcome with a doxorubicin-containing regimen. J Clin Oncol. 2002;20:1087–93.

    Article  PubMed  CAS  Google Scholar 

  8. Enblad G, Glimelius B, Sundstrom C. Treatment outcome in Hodgkin’s disease in patients above the age of 60: a population-based study. Ann Oncol. 1991;2:297–302.

    PubMed  CAS  Google Scholar 

  9. Evens AM, Sweetenham JW, Horning SJ. Hodgkin lymphoma in older patients: an uncommon disease in need of study. Oncol Williston Park. 2008;22:1369–79.

    Google Scholar 

  10. Proctor SJ, Rueffer JU, Angus B, et al. Hodgkin’s disease in the elderly: current status and future directions. Ann Oncol. 2002;13 Suppl 1:133–7.

    PubMed  Google Scholar 

  11. Hamlin PA. Treatment of aggressive non-Hodgkin’s and Hodgkin’s lymphoma in older patients. In: American Society of Clinical Oncology. Educational Book; 2007. p. 295–99.

  12. Parkin DM, Muir CS. Cancer incidence in five continents. Comparability and quality of data. IARC Sci Publ. 1992;6:45–173.

    Google Scholar 

  13. Taylor PR, Angus B, Owen JP, Proctor SJ. Hodgkin’s disease: a population-adjusted clinical epidemiology study (PACE) of management at presentation. Northern Region Lymphoma Group. QJM. 1998;91:131–9.

    Article  PubMed  CAS  Google Scholar 

  14. Miller T, LeBlanc M, Braziel R, et al. Was the bimodal age incidence of Hodgkin’s lymphoma a result of mistaken diagnosis of non-Hodgkin’s lymphoma? [abstract 3048]. Presented at the 44th Annual Meeting of the American Society of Hematology. Philadelphia, USA; 2002, December 6–10.

  15. Mir R, Anderson J, Strauchen J, et al. Hodgkin disease in patients 60 years of age or older. Histologic and clinical features of advanced-stage disease. The Cancer and Leukemia Group B. Cancer. 1993;71:1857–66.

    Article  PubMed  CAS  Google Scholar 

  16. Roy P, Vaughan Hudson G, Vaughan Hudson B, et al. Long-term survival in Hodgkin’s disease patients. A comparison of relative survival in patients in trials and those recorded in population-based cancer registries. Eur J Cancer. 2000;36:384–9.

    Article  PubMed  CAS  Google Scholar 

  17. Landgren O, Algernon C, Axdorph U, et al. Hodgkin’s lymphoma in the elderly with special reference to type and intensity of chemotherapy in relation to prognosis. Haematologica. 2003;88:438–44.

    PubMed  Google Scholar 

  18. Proctor SJ, White J, Jones GL. An international approach to the treatment of Hodgkin’s disease in the elderly: launch of the SHIELD study programme. Eur J Haematol Suppl. 2005;75:63–7.

    Google Scholar 

  19. Stark GL, Wood KM, Jack F, et al. Hodgkin’s disease in the elderly: a population-based study. Br J Haematol. 2002;119:432–40.

    Article  PubMed  Google Scholar 

  20. Guinee VF, Giacco GG, Durand M, et al. The prognosis of Hodgkin’s disease in older adults. J Clin Oncol. 1991;9:947–53.

    PubMed  CAS  Google Scholar 

  21. Jarrett RF, Stark GL, White J, et al. Impact of tumor Epstein-Barr virus status on presenting features and outcome in age-defined subgroups of patients with classic Hodgkin lymphoma: a population-based study. Blood. 2005;106:2444–51.

    Article  PubMed  CAS  Google Scholar 

  22. • Diepstra A, van Imhoff GW, Schaapveld M, et al. Latent Epstein-Barr virus infection of tumor cells in classical Hodgkin’s lymphoma predicts adverse outcome in older adult patients. J Clin Oncol. 2009;27:3815–21. This study showed that EBV positivity was associated with a worse failure-free survival in older HL patients compared with younger patients.

    Article  PubMed  Google Scholar 

  23. van Spronsen DJ, Janssen-Heijnen ML, Breed WP, Coebergh JW. Prevalence of co-morbidity and its relationship to treatment among unselected patients with Hodgkin’s disease and non-Hodgkin’s lymphoma, 1993–1996. Ann Hematol. 1999;78:315–9.

    Article  PubMed  Google Scholar 

  24. Levis A, Anselmo AP, Ambrosetti A, et al. VEPEMB in elderly Hodgkin’s lymphoma patients. Results from an Intergruppo Italiano Linfomi (IIL) study. Ann Oncol. 2004;15:123–8.

    Article  PubMed  CAS  Google Scholar 

  25. Proctor SJ, Wilkinson J. A web-based study concept designed to progress clinical research for ‘orphan’ disease areas in haematological oncology in the elderly: the SHIELD programme. Crit Rev Oncol Hematol. 2007;61:79–83.

    Article  PubMed  CAS  Google Scholar 

  26. Extermann M, Aapro M, Bernabei R, et al. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 2005;55:241–52.

    Article  PubMed  Google Scholar 

  27. Levis A, Depaoli L, Urgesi A, et al. Probability of cure in elderly Hodgkin’s disease patients. Haematologica. 1994;79:46–54.

    PubMed  CAS  Google Scholar 

  28. Kim HK, Silver B, Li S, et al. Hodgkin’s disease in elderly patients (> or =60): clinical outcome and treatment strategies. Int J Radiat Oncol Biol Phys. 2003;56:556–60.

    Article  PubMed  Google Scholar 

  29. Specht L, Nissen NI. Hodgkin’s disease and age. Eur J Haematol. 1989;43:127–35.

    Article  PubMed  CAS  Google Scholar 

  30. Ballova V, Ruffer JU, Haverkamp H, et al. A prospectively randomized trial carried out by the German Hodgkin Study Group (GHSG) for elderly patients with advanced Hodgkin’s disease comparing BEACOPP baseline and COPP-ABVD (study HD9elderly). Ann Oncol. 2005;16:124–31.

    Article  PubMed  CAS  Google Scholar 

  31. Enblad G, Gustavsson A, Sundstrom C, Glimelius B. Patients above sixty years of age with Hodgkin’s lymphoma treated with a new strategy. Acta Oncol. 2002;41:659–67.

    Article  PubMed  Google Scholar 

  32. Levis A, Merli F, Tamiazzo S, et al. ABVD versus VEPEMB in elderly Hodgkin’s lymphoma patients [abstract 2322]. Presented at the 49th Annual Meeting of the American Society of Hematology. Atlanta, USA; 2007, December 8–11.

  33. Levis A, Depaoli L, Bertini M, et al. Results of a low aggressivity chemotherapy regimen (CVP/CEB) in elderly Hodgkin’s disease patients. Haematologica. 1996;81:450–6.

    PubMed  CAS  Google Scholar 

  34. Zinzani PL, Magagnoli M, Bendandi M, et al. Efficacy of the VBM regimen in the treatment of elderly patients with Hodgkin’s disease. Haematologica. 2000;85:729–32.

    PubMed  CAS  Google Scholar 

  35. Macpherson N, Klasa RJ, Gascoyne R, et al. Treatment of elderly Hodgkin’s lymphoma patients with a novel 5-drug regimen (ODBEP): a phase II study. Leuk Lymphoma. 2002;43:1395–402.

    Article  PubMed  CAS  Google Scholar 

  36. Brusamolino E, Bacigalupo A, Barosi G, et al. Classical Hodgkin’s lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up. Haematologica. 2009;94:550–65.

    Article  PubMed  Google Scholar 

  37. Repetto L, Biganzoli L, Koehne CH, et al. EORTC Cancer in the Elderly Task Force guidelines for the use of colony-stimulating factors in elderly patients with cancer. Eur J Cancer. 2003;39:2264–72.

    Article  PubMed  CAS  Google Scholar 

  38. Doorduijn JK, van der Holt B, van Imhoff GW, et al. CHOP compared with CHOP plus granulocyte colony-stimulating factor in elderly patients with aggressive non-Hodgkin’s lymphoma. J Clin Oncol. 2003;21:3041–50.

    Article  PubMed  CAS  Google Scholar 

  39. Bohlius J, Reiser M, Schwarzer G, Engert A. Impact of granulocyte colony-stimulating factor (CSF) and granulocyte-macrophage CSF in patients with malignant lymphoma: a systematic review. Br J Haematol. 2003;122:413–23.

    Article  PubMed  CAS  Google Scholar 

  40. Klimm B, Eich HT, Haverkamp H, et al. Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin’s lymphoma: an analysis from the German Hodgkin Study Group. Ann Oncol. 2007;18:357–63.

    Article  PubMed  CAS  Google Scholar 

  41. Kolstad A, Nome O, Delabie J, et al. Standard CHOP-21 as first line therapy for elderly patients with Hodgkin’s lymphoma. Leuk Lymphoma. 2007;48:570–6.

    Article  PubMed  CAS  Google Scholar 

  42. • Engert A, Plutschow A, Eich HT, et al. Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med. 2010;363:640–52. The HD10 trial was able to demonstrate that two cycles of ABVD followed by 20 Gy IF-RT are equally effective but less toxic than four cycles of ABVD followed by 30 Gy IF-RT. Thus a new standard could be established for the treatment of patients in early favorable stages.

    Article  PubMed  CAS  Google Scholar 

  43. • Halbsguth TV, Nogova L, Mueller H, et al. Phase 2 study of BACOPP (bleomycin, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) in older patients with Hodgkin lymphoma: a report from the German Hodgkin Study Group (GHSG). Blood. 2010;116:2026–32. The new BACOPP regimen failed to improve the outcome of older HL patients in advanced stages because of an unsatisfactory rate of therapy-related deaths.

    Article  PubMed  CAS  Google Scholar 

  44. Kobe C, Dietlein M, Franklin J, et al. Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma. Blood. 2008;112:3989–94.

    Article  PubMed  CAS  Google Scholar 

  45. Lopez A, Gutierrez A, Palacios A, et al. GEMOX-R regimen is a highly effective salvage regimen in patients with refractory/relapsing diffuse large-cell lymphoma: a phase II study. Eur J Haematol. 2008;80:127–32.

    Article  PubMed  CAS  Google Scholar 

  46. Lennard AL, Carey PJ, Jackson GH, Proctor SJ. An effective oral combination in advanced relapsed Hodgkin’s disease prednisolone, etoposide, chlorambucil and CCNU. Cancer Chemother Pharmacol. 1990;26:301–5.

    Article  PubMed  CAS  Google Scholar 

  47. • Proctor SJ, Lennard AL, Jackson GH, et al. The role of an all-oral chemotherapy containing lomustine (CCNU) in advanced,fs progressive Hodgkin lymphoma: a patient-friendly palliative option which can result in long-term disease control. Ann Oncol. 2010;21:426–8. The schedule induced a CR in seven patients, suggesting that regimens containing CCNU may be beneficial for the treatment of older patients with relapsed HL.

    Article  PubMed  CAS  Google Scholar 

  48. Santoro A, Bredenfeld H, Devizzi L, et al. Gemcitabine in the treatment of refractory Hodgkin’s disease: results of a multicenter phase II study. J Clin Oncol. 2000;18:2615–9.

    PubMed  CAS  Google Scholar 

  49. Andersson PO, Braide I, Nilsson-Ehle H. Trofosfamide as salvage therapy for anaplastic large cell lymphoma relapsing after high-dose chemotherapy. Leuk Lymphoma. 2002;43:2351–3.

    Article  PubMed  CAS  Google Scholar 

  50. Latz D, Nassar N, Frank R. Trofosfamide in the palliative treatment of cancer: a review of the literature. Onkologie. 2004;27:572–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. First Department of Internal Medicine, German Hodgkin Study Group (GHSG), University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Teresa V. Halbsguth, Boris Böll, Peter Borchmann & Volker Diehl

Authors
  1. Teresa V. Halbsguth
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Boris Böll
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Peter Borchmann
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Volker Diehl
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Teresa V. Halbsguth.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Halbsguth, T.V., Böll, B., Borchmann, P. et al. The Unique Characteristics and Management of Patients Over 60 Years of Age with Classic Hodgkin Lymphoma. Curr Hematol Malig Rep 6, 164–171 (2011). https://doi.org/10.1007/s11899-011-0089-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11899-011-0089-7

Keywords