Magnus Björkholm1, Erik Svedmyr, Jan Sjöberg. 1. Division of Hematology, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden. magnus.bjorkholm@karolinska.se
Abstract
PURPOSE OF REVIEW: To review Hodgkin lymphoma in older adults with regard to epidemiology, disease characteristics, prognosis, treatment, and future developments. RECENT FINDINGS: Older Hodgkin lymphoma patients defined by chronological age represent a heterogeneous population in terms of life expectancy, morbidities, and functional status. Twenty-one percent of Swedish Hodgkin lymphoma patients are greater than 65 years (5%, >81 years) at diagnosis. In general, less than 10% of patients included in broad clinical trials are greater than 60 years. The proportion of mixed cellularity histopathology and EBV-genome-positive tumors is higher in older adults. Five-year relative survival of Swedish patients 66-80 and greater than 81 years is 0.58 and 0.26, respectively. Older patients have lower remission rates, but relapse-free survival is less impaired. No standard treatment recommendations exist. In older fit patients less than 65-70 years--go for 'young' treatment. Estimate thoroughly the individual patient's frailness/comorbidities in order to properly adjust treatment, thus saving patients from over/undertreatment. The use of early PET should be optimized in clinical practice. Representativeness of large clinical trials including evaluation of functional status and comorbidity remains crucial. SUMMARY: Elderly Hodgkin lymphoma patients still do poorly and improved prognostics, personalized and targeted treatment options associated with fewer side-effects will hopefully advance the clinical Hodgkin lymphoma field.
PURPOSE OF REVIEW: To review Hodgkin lymphoma in older adults with regard to epidemiology, disease characteristics, prognosis, treatment, and future developments. RECENT FINDINGS: Older Hodgkin lymphomapatients defined by chronological age represent a heterogeneous population in terms of life expectancy, morbidities, and functional status. Twenty-one percent of Swedish Hodgkin lymphomapatients are greater than 65 years (5%, >81 years) at diagnosis. In general, less than 10% of patients included in broad clinical trials are greater than 60 years. The proportion of mixed cellularity histopathology and EBV-genome-positive tumors is higher in older adults. Five-year relative survival of Swedish patients 66-80 and greater than 81 years is 0.58 and 0.26, respectively. Older patients have lower remission rates, but relapse-free survival is less impaired. No standard treatment recommendations exist. In older fit patients less than 65-70 years--go for 'young' treatment. Estimate thoroughly the individual patient's frailness/comorbidities in order to properly adjust treatment, thus saving patients from over/undertreatment. The use of early PET should be optimized in clinical practice. Representativeness of large clinical trials including evaluation of functional status and comorbidity remains crucial. SUMMARY: Elderly Hodgkin lymphomapatients still do poorly and improved prognostics, personalized and targeted treatment options associated with fewer side-effects will hopefully advance the clinical Hodgkin lymphoma field.
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