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Flow-sorting and Exome Sequencing of the Reed-Sternberg Cells of Classical Hodgkin Lymphoma
Published on: June 10, 2017
Greater attention should be paid to developing therapies for elderly patients with Hodgkin lymphoma-A
Magnus Björkholm1, Caroline E Weibull2, Sandra Eloranta3
1Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden.
Insights
Older adults over 50 represent a significant portion of Hodgkin lymphoma patients, facing poorer outcomes and underrepresentation in clinical trials. This study highlights their unmet medical needs and advocates for increased trial inclusion.
Area of Science:
- Oncology
- Hematology
- Epidemiology
Background:
- A substantial proportion (40%) of Hodgkin lymphoma (HL) patients are diagnosed over 50 years old.
- Older HL patients exhibit significantly worse prognoses compared to younger counterparts.
- Elderly patients are infrequently enrolled in clinical trials, limiting evidence-based treatment strategies.
Purpose of the Study:
- To analyze survival outcomes in elderly Hodgkin lymphoma patients.
- To assess trends in survival and patient characteristics over time.
- To underscore the need for improved clinical trial access for older adults.
Main Methods:
- Utilized data from the Swedish Cancer and Lymphoma Registries.
- Included 7997 Hodgkin lymphoma patients diagnosed between 1973 and 2013.
- Estimated relative survival ratios (RSRs) stratified by age and sex.
Main Results:
- Survival rates significantly decrease with advancing age, particularly for those over 70.
- No substantial improvements in survival were observed for patients aged 45-69 between 2000-2013.
- Modest survival improvements were noted for patients aged 70 and older during the same period.
- Patient and disease characteristics remained consistent across the study period.
Conclusions:
- Elderly Hodgkin lymphoma patients represent a demographic with significant unmet medical needs.
- Findings support a more proactive strategy for incorporating older patients into clinical trials.
- This research establishes a crucial baseline for evaluating new therapies, including targeted drugs, in the elderly population.
Objective:
Forty percent of Hodgkin lymphoma (HL) patients are older than 50 years at diagnosis, a fact which is not commonly recognized. Older patients do significantly worse than younger patients and are rarely included in clinical trials.
Methods:
Using data from Swedish Cancer and Lymphoma Registries, we estimated relative survival ratios (RSRs) for 7997 HL patients (diagnosed 1973-2013; 45% ≥50 years).
Results:
The 1-year RSRs (95% confidence interval; CI) for males aged 45-59, 60-69, 70-80, and 81 years and over, diagnosed in 2013, were 0.95 (0.91-0.97), 0.88 (0.81-0.92), 0.74 (0.63-0.81), and 0.52 (0.35-0.67), respectively. The corresponding 1-year RSRs for females were 0.97 (0.94-0.98), 0.91 (0.85-0.95), 0.82 (0.73-0.88), and 0.66 (0.50-0.77). No improvements in 1-year of 5-year relative survival from 2000 to 2013 were observed for patients aged 45-59 or 60-69 but there were modest improvements for patients aged 70 years and older. Importantly, we saw no changes in the distribution of disease or patient characteristics between 2000 and 2013.
Conclusions:
Elderly patients constitute a large group with clearly unmet medical needs. Our findings motivate a more active approach to including elderly patients in clinical trials. Our study provides a baseline for outcome comparison after the broader introduction of targeted drugs.
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