Sykorova A, Mocikova H, Lukasova M, Koren J, Stepankova P, Prochazka V, Belada D, Klaskova K, Gaherova L, Chroust K, Buresova L, Markova J
4th Department of Internal Medicine - Hematology, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic.
Department of Clinical Hematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Leuk Res. 2020 Mar;90:106311. doi: 10.1016/j.leukres.2020.106311. Epub 2020 Jan 24.
The optimal management of elderly patients (pts) with Hodgkin's lymphoma is not yet defined. The aims of the present study were: 1) to evaluate clinical and laboratory characteristics of elderly pts; 2) to indentify risk factors for unfavorable outcome.
The outcome of 182 pts ≥ 60 years (y) was retrospectively analyzed (median age, 67y). Mixed cellularity histology was diagnosed in 49.5 %, advanced stage of disease was in 68.7 % pts, CIRS > 3 in 35.7 %, ECOG PS ≥ 2 in 22.9 % (60-69y) of pts. Chemotherapy (CMT) alone was used in 69.2 % and combination of CMT and radiotherapy in 26.9 % of pts. Anthracycline-based CMT received 83.5 % of pts. The median follow-up was 4.5y.
The overall response/complete remission rate was 85.6/70.7 %. The median progression free survival (PFS) and overall survival (OS) were 10y and 11.3y, respectively. Estimated 5-y PFS and 5-y OS were 65.7 % (in contrast to 98.2 % in pts < 60y; p < 0.001) and 70.5 % (99.4 % in pts < 60y; p < 0.001). Overall 70 (38.5 %) elderly pts died. The independent risk factors for a shorter OS included CIRS > 3, lymphopenia < 8 % and anthracycline-free CMT, for a shorter PFS anthracycline-free CMT and lymphopenia < 8 %.
CIRS > 3, lymphopenia < 8 % and anthracycline-free chemotherapy appear to be significant for unfavorable outcome.
老年霍奇金淋巴瘤患者的最佳治疗方案尚未明确。本研究的目的是：1）评估老年患者的临床和实验室特征；2）确定不良预后的危险因素。
回顾性分析了182例年龄≥60岁（中位年龄67岁）的患者。49.5%的患者诊断为混合细胞型组织学，68.7%的患者处于疾病晚期，35.7%的患者CIRS>3，22.9%（60 - 69岁）的患者ECOG体能状态≥2。69.2%的患者仅接受化疗，26.9%的患者接受化疗与放疗联合治疗。83.5%的患者接受了含蒽环类药物的化疗。中位随访时间为4.5年。
总缓解率/完全缓解率分别为85.6%/70.7%。中位无进展生存期（PFS）和总生存期（OS）分别为10年和11.3年。估计5年PFS和5年OS分别为65.7%（相比之下，<60岁患者为98.2%；p<0.001）和70.5%（<60岁患者为99.4%；p<0.001）。共有70例（38.5%）老年患者死亡。OS较短的独立危险因素包括CIRS>3、淋巴细胞减少<8%和不含蒽环类药物的化疗，PFS较短的危险因素为不含蒽环类药物的化疗和淋巴细胞减少<8%。
CIRS>3、淋巴细胞减少<8%和不含蒽环类药物的化疗似乎是不良预后的重要因素。
