German Hodgkin Study Group and Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
Br J Haematol. 2019 Jan;184(1):82-92. doi: 10.1111/bjh.15652. Epub 2018 Nov 8.
The outcome of patients with Hodgkin lymphoma (HL) has dramatically improved over the past decades and continues to improve with the development of novel targeted therapies, such as the immunoconjugate brentuximab vedotin and the checkpoint inhibitors nivolumab and pembrolizumab. Moreover, with the use of response-adapted strategies using positron-emission-tomography (PET), the overall intensity of treatment for most patients can be reduced, resulting in less acute and late toxicity. However, these advances are mainly restricted to younger patients, as advances in patients above the age of 60 years ('older' patients) have been much less pronounced. Furthermore, about one third of all HL patients are among the older population, but only 5-10% of the patients treated in current HL clinical trials are ≥60 years old. HL in older patients is characterized by aggressive disease and unfavourable prognostic features as B symptoms and predominance of advanced stages. In addition, tolerance to curative chemotherapy is drastically reduced in older patients resulting in excessive toxicity and insufficient treatment due to therapy delays and dose reductions. Therefore, there is a significant unmet medical need in older HL patients for less toxic and effective therapies, and an important gap of knowledge concerning this growing population of patients. Recent advances on epidemiology, characteristics and treatment of older HL patients will be summarized in this article.
过去几十年来，霍奇金淋巴瘤（HL）患者的预后显著改善，随着新型靶向治疗药物的发展，如免疫偶联药物 Brentuximab vedotin 以及检查点抑制剂 nivolumab 和 pembrolizumab，这种改善仍在继续。此外，随着正电子发射断层扫描（PET）在应答适应性策略中的应用，大多数患者的整体治疗强度可以降低，从而减少急性和迟发性毒性。然而，这些进展主要局限于年轻患者，因为 60 岁以上患者（“老年”患者）的进展要小得多。此外，大约三分之一的 HL 患者属于老年人群，但目前 HL 临床试验中治疗的患者中只有 5-10%年龄在 60 岁以上。老年 HL 患者的疾病具有侵袭性和不良预后特征，如 B 症状和晚期阶段为主。此外，老年患者对治愈性化疗的耐受性大大降低，导致治疗延迟和剂量减少，从而导致过度毒性和治疗不足。因此，老年 HL 患者对毒性更低、疗效更高的治疗方法存在明显的未满足的医疗需求，并且对这一不断增长的患者群体的认识存在重要差距。本文将总结老年 HL 患者的流行病学、特征和治疗方面的最新进展。
