How we treat elderly patients with Hodgkin lymphoma

To review Hodgkin lymphoma in older adults with regard to epidemiology, disease characteristics, prognosis, treatment, and future developments.

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.

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.