Department I of Internal Medicine, German Hodgkin Study Group (GHSG).
Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital of Cologne.
Curr Opin Oncol. 2018 Sep;30(5):308-316. doi: 10.1097/CCO.0000000000000464.
We aim to summarize the current knowledge on the treatment of elderly Hodgkin lymphoma patients with a focus on evidence from clinical trials and novel drugs.
For elderly Hodgkin lymphoma patients above 60 years without precluding comorbidities a curative treatment approach is warranted. Early favorable stage patients should receive two cycles of multiagent chemotherapy followed by 20 Gy localized radiotherapy. Early unfavorable stage patients should receive four cycles of multiagent chemotherapy followed by 30 Gy localized radiotherapy. For advanced stage patients six cycles of multiagent chemotherapy can be recommended and should be followed by localized radiotherapy on residual disease manifestations. Relapsed or refractory patients should be treated in an individually tailored approach that considers both the patient's objectives and comorbidities. The antibody-drug conjugate brentuximab vedotin is a very effective option for elderly patients with a high response rate albeit limited durability. Anti-programed cell death protein 1 antibodies might also be effective in elderly Hodgkin lymphoma patients with a mechanism of action distinct from chemotherapy.
In conclusion, the goal of treatment in newly diagnosed elderly Hodgkin lymphoma patients is curative whenever possible and prospective and retrospective evidence has shown that this is feasible for all disease stages with a variety of multiagent chemotherapy regimen. Relapsed and refractory elderly Hodgkin lymphoma patients can mostly only be treated with the goal of palliation. However, it remains to be seen if novel substances and new combination regimen are able to change that.
我们旨在总结老年霍奇金淋巴瘤患者的治疗现状，重点关注临床试验和新型药物的证据。
对于无合并症的 60 岁以上老年霍奇金淋巴瘤患者，应采用根治性治疗方法。早期有利的分期患者应接受两周期联合化疗，随后进行 20Gy 局部放疗。早期不利分期患者应接受四周期联合化疗，随后进行 30Gy 局部放疗。对于晚期患者，可推荐进行六周期联合化疗，并在残留病灶上进行局部放疗。对于复发或难治性患者，应根据患者的目标和合并症，采取个体化治疗方法。抗体药物偶联物 Brentuximab vedotin 是一种非常有效的治疗老年患者的药物，具有较高的缓解率，但持续时间有限。抗程序性死亡蛋白 1 抗体也可能对老年霍奇金淋巴瘤患者有效，其作用机制与化疗不同。
总之，新诊断的老年霍奇金淋巴瘤患者的治疗目标是尽可能治愈，前瞻性和回顾性证据表明，对于所有分期的患者，采用多种联合化疗方案均具有可行性。复发和难治性老年霍奇金淋巴瘤患者大多只能采用姑息治疗。然而，新型药物和新的联合方案是否能够改变这种情况，还有待观察。
