Journal article
Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma
Blood advances, Vol.5(18), pp.3623-3632
09/28/2021
DOI: 10.1182/bloodadvances.2021004645
PMCID: PMC8945583
PMID: 34448831
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 = 44 (18%) had total scores ≥10. Using multivariable Cox models, only ADL loss predicted shorter progression-free (PFS; hazard ratio [HR] 2.13, P = .007) and overall survival (OS; HR 2.52, P = .02). Most patients (n = 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 = .0007) and OS (HR 0.31, P = .0003). Survival was similar following conventional chemotherapy in those ages 60-69 vs ≥70: PFS HR 0.88, P = .63; OS HR 0.73, P = .55. Early treatment discontinuation due to toxicity was more common with CIRS-G ≥10 (28% vs 12%, P = .016) or documented geriatric syndrome (28% vs 13%, P = .02). A competing risk analysis demonstrated improved disease-related survival with conventional therapy (HR 0.29, P = .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.
Details
- Title: Subtitle
- Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma
- Creators
- Victor M Orellana-Noia - University of VirginiaKrista Isaac - University of VirginiaMary-Kate Malecek - Washington University in St. LouisNancy L Bartlett - Washington University in St. LouisTimothy J Voorhees - University of North Carolina at Chapel HillNatalie S Grover - University of North Carolina at Chapel HillSteven R Hwang - Division of Hematology, Mayo Clinic, Rochester, MNN Nora Bennani - Mayo ClinicRachel Hu - Cleveland ClinicBrian T Hill - Cleveland ClinicEric Mou - University of IowaRanjana H Advani - Stanford UniversityJordan Carter - Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,Kevin A David - Rutgers, The State University of New JerseyHatcher J Ballard - Hospital of the University of PennsylvaniaJakub Svoboda - Hospital of the University of PennsylvaniaMichael C Churnetski - Emory UniversityGabriela Magarelli - Hackensack Meridian HealthTatyana A Feldman - Hackensack Meridian HealthJonathon B Cohen - Emory UniversityAndrew M Evens - Rutgers, The State University of New JerseyCraig A Portell - University of Virginia
- Resource Type
- Journal article
- Publication Details
- Blood advances, Vol.5(18), pp.3623-3632
- DOI
- 10.1182/bloodadvances.2021004645
- PMID
- 34448831
- PMCID
- PMC8945583
- NLM abbreviation
- Blood Adv
- ISSN
- 2473-9529
- eISSN
- 2473-9537
- Grant note
- K12 CA237806 / NCI NIH HHS UL1 TR002378 / NCATS NIH HHS P30 CA044579 / NCI NIH HHS
- Language
- English
- Date published
- 09/28/2021
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359671502771
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