Evens Andrew M, Sweetenham John W, Horning Sandra J
Feinberg School of Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, USA.
Oncology (Williston Park). 2008 Nov 15;22(12):1369-79.
Elderly Hodgkin lymphoma (HL), commonly defined as occuring in patients over 60 to 65 years of age, is an uncommon disease. In population-based studies, the proportion of HL patients over age 60 years has rangedfrom 15% to 30%. However, the proportion of patients over age 60 years in clinical trials has been considerably lower, typically constituting < 5% to 10% of participants. Elderly HL patients commonly present with mixed cellularity histology, B symptoms, advanced stage, and Epstein-Barr virus-positive disease. Progression-free and overall survival rates for elderly HL patients are disproportionately inferior to those of younger patients. Generally, treatment of elderly HL for all disease stages should be given with curative intent, but more effective, tolerable therapeutic regimens are needed. No standard treatment recommendations exist for elderly HL Bleomycin-containing regimens including ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, dacarbazine) are associated with pulmonary toxicity, and intensive therapy such as BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine [Oncovin], procarbazine [Matulane], prednisone) is poorly tolerated, whereas less-intensive regimens such as CVP/CEB (chlorambucil [Leukeran], vinblastine, procarbazine, prednisone, cyclophosphamide, etoposide, bleomycin) and ChlVPP (chlorambucil, vinblastine, procarbazine, prednisolone) appear to be less effective than anthracycline-based regimens. Recent data using CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) in this population merit further investigation. In addition, further evaluation of the prognostic value of early PET in elderly HL is warranted. Continued multicenter collaborations with prospective clinical trials, including formal assessment of comorbidity and functional status, will be critical to the successful study of elderly HL.
老年霍奇金淋巴瘤（HL）通常定义为发生在60至65岁以上患者中的疾病，是一种罕见疾病。在基于人群的研究中，60岁以上HL患者的比例在15%至30%之间。然而，临床试验中60岁以上患者的比例要低得多，通常占参与者的<5%至10%。老年HL患者通常表现为混合细胞性组织学、B症状、晚期和爱泼斯坦-巴尔病毒阳性疾病。老年HL患者的无进展生存率和总生存率明显低于年轻患者。一般来说，老年HL所有疾病阶段的治疗都应以治愈为目的，但需要更有效、可耐受的治疗方案。目前尚无针对老年HL的标准治疗建议。含博来霉素的方案，包括ABVD（多柔比星[阿霉素]、博来霉素、长春花碱、达卡巴嗪）与肺毒性相关，而BEACOPP（博来霉素、依托泊苷、多柔比星、环磷酰胺、长春新碱[安可平]、丙卡巴肼[甲基苄肼]、泼尼松）等强化疗法耐受性差，而CVP/CEB（苯丁酸氮芥[瘤可宁]、长春花碱、丙卡巴肼、泼尼松、环磷酰胺、依托泊苷、博来霉素）和ChlVPP（苯丁酸氮芥、长春花碱、丙卡巴肼、泼尼松龙）等强度较低的方案似乎比基于蒽环类药物的方案效果差。近期在该人群中使用CHOP（环磷酰胺、多柔比星、长春新碱、泼尼松）的数据值得进一步研究。此外，有必要进一步评估早期PET在老年HL中的预后价值。继续开展多中心合作并进行前瞻性临床试验，包括对合并症和功能状态的正式评估，对于成功研究老年HL至关重要。
