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

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.