Originally published as JCO Early Release 10.1200/JCO.2005.11.080 on June 13 2005

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Hodgkin's Lymphoma in Elderly Patients: A Comprehensive Retrospective Analysis From the German Hodgkin's Study Group

From the Department I of Internal Medicine, University of Cologne; German Hodgkin Study Group, University of Cologne, Cologne; Department of Radiation Oncology, Ludwig Maximilian Universität München, Munich; and Department of Pathology, University Hospital of Würzburg, Germany

Address reprint requests to Andreas Engert, MD, Department of Internal Medicine I, University Hospital of Cologne, Kerpener Str 62, 50924 Cologne, Germany; e-mail: a.engert{at}uni-koeln.de

PURPOSE: With improved prognosis for patients with Hodgkin's lymphoma (HL), interest increasingly focuses on high-risk groups such as elderly patients. We thus performed a retrospective analysis using the German Hodgkin's Study Group (GHSG) database to determine clinical risk factors, course of treatment, and outcome in elderly HL patients in comparison with younger adults.

PATIENTS AND METHODS: A total of 4,251 patients included in the GHSG studies HD5 to HD9 were analyzed, of whom 372 (8.8%) were 60 years or older and 3,879 (91.2%) were younger than 60 years. Patient characteristics, treatment results, toxicity, freedom from treatment failure (FFTF), and overall survival (OS) were compared.

RESULTS: Elderly patients more often had mixed cellularity subtype, "B" symptoms, elevated erythrocyte sedimentation rate, and poorer performance status. Less frequently observed were nodular sclerosis subtype, large mediastinal mass, and bulky disease. Acute toxicity during chemotherapy was generally higher in elderly patients. This was most obvious for severe infections (grade 3 or 4; 15% v 6%) correlating with more severe leukopenia in elderly patients (grade 4; 38% v 23%). As a result, significantly fewer elderly patients received the intended full chemotherapy dose (75% v 91%). The survival analysis showed a significantly poorer treatment outcome for elderly patients in terms of 5-year OS (65% v 90%), FFTF (60% v 80%), and HL-specific FFTF (73% v 82%).

CONCLUSION: Elderly patients have a poorer risk profile compared with younger HL patients and experience more severe treatment-associated toxicity. Higher mortality during treatment as well as lower dose-intensity are the major factors explaining the poorer overall outcome of elderly HL patients.

Supported by The German Hodgkin's Study Group, which is supported by the Deutsche Krebshilfe and is part of the Kompetenznetz Maligne Lymphome, which is supported by the Bohdesministerium für Bilding und Forschung.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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