Older Patients With Hodgkin Lymphoma: A Contemporary Review

Older patients age >60 years with advanced-stage cHL have historically had poorer outcomes, attributed to comorbid conditions, performance status, and chemotherapy intolerance. The use of an anthracycline-based chemotherapy backbone has shown strong correlation with improved survival, and the intent of treatment remains curative even in the older population. Strategies to help mitigate treatment toxicity to allow for treatment continuation remain one of the greatest concerns in the treatment of older cHL patients. Avoidance of bleomycin, use of G-CSF in brentuximab vedotin (BV)-AVD, and the use of comprehensive geriatric assessments to assess fitness have allowed for more tailored therapy with improved outcomes in older cHL patients. In clinical practice, identification of comorbid conditions or functional deficits using a comprehensive geriatric assessment allows the provider to intervene earlier, modify risk factors, provider supportive care, and possibly modify therapy based on frailty index. Despite these advances, a standardized frontline treatment regimen has not been universally recognized, but recent advances with the use of targeted therapies such as BV or nivolumab have demonstrated improved outcomes. The recent subset analysis of older patients with advanced-stage cHL treated with N-AVD is the first to suggest an OS benefit in oHL patients, with an acceptable toxicity and tolerability profile. The S1826 study assessed patient-reported QOL measures longitudinally and found that older patients treated with BV-AVD experienced more self-reported neuropathy, diarrhea, and arthralgias/myalgias compared with those on N-AVD. The self-reported tolerability and physician-reported toxicity profile of the S1826 regimen with N-AVD supports the emerging use of N-AVD as frontline therapy in older patients with advanced-stage cHL. Further research is ongoing to tailor treatments for older patients with cHL.