A. Sykorova1, H. Mocikova2, M. Lukasova3, J. Koren4, P. Stepankova1, V. Prochazka3, D. Belada1, K. Klaskova2, L. Gaherova2, K. Chroust5, L. Buresova5, J. Markova2, On Behalf Of The Czech Hodgkin Lymphoma Group
1 4th Department of Internal Medicine – Hematology, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic, 2 Department of Clinical Hematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic, 3 Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic, 4 1st Department of Medicine – Department of Hematology, Charles University, General Hospital, Prague, Czech Republic, 5 DSC Services, Tišnov, Czech Republic
Introduction: The optimal management of elderly Hodgkin (HL) patients (pts) is not yet defined due to comorbidities and poor tolerance of chemotherapy (CT) and/or radiotherapy (RT).
The purpose of this study was to analyze treatment toxicity of the first-line treatment in elderly HL pts with advanced stage prospectively registered in Hodgkin Lymphoma Project in the Czech Republic.
Patients and methods: We analyzed 125 pts ≥ 60 years (y) with classical HL in advanced stage diagnosed between 1999 and 2016. Median age was 67 y (range 60–84). Chemotherapy alone was used in 109 (87.2%) of pts. The combined modality of treatment (CT and RT) was used in 14 pts (11.2%). Anthracycline-based CT received 84% of pts (105 pts), 50.4% of pts were treated with ABVD regimen.
Results: Median number of administered CT cycles was 6 (range 1–8). G – CSF was used in 82 of pts and the median number of CT cycles with G – CSF administration was six cycles (range 1–8). Overall response rate after the first-line treatment was observed in 104 (83.2%) including complete remission in 67.2%, stable disease in 0.8% and primary disease progression in 6.4%. Bleomycin toxicity grade ≥ three was observed in 12/98 (12.2%) of pts. Other toxicities grade ≥ three according to CTCAE v4 included: cardiac in 9 (7.2%), neurologic in 5 (4%), infections in 27 (21.6%) and other toxicities in 5 (4%) of pts. Overall 51 pts (40.8%) died. The highest mortality rate in this group was caused by HL progression (31.3%). Treatment-related mortality was 25.4%, including cardiac in 1 (0.66%) and pulmonary toxicities in 2 (3.9%) pts. Other causes of mortality included: infections in 3.9%, secondary malignancy in 9.8%, other cause in 11.8% and unknown cause in 17.6% of pts.
Conclusions: The most frequent cause of mortality is HL progression. Bleomycin toxicity in our group of elderly pts is comparable with other reported data. According to our data treatment related death of elderly pts is high. Prospective clinical studies are still needed to determine an optimal effective regimen with low toxicity in elderly pts. Long-term survival of our pts depended on the use of anthracycline-containing CT and value of lymphocytes (multivariate analysis).
This work was supported by a grant awarded by AZV 16–29857A, Research project Q 28 Progres awarded by Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic, by grant 16–31092A and Research project Q 40/08 Progres.