Çokgezer Simay, Elverdi Tuğrul, Salihoğlu Ayşe, Ar Muhlis Cem, Öngören Şeniz, Başlar Zafer, Eşkazan Ahmet Emre
Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey.
Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey.
Cancer Manag Res. 2022 Jun 7;14:1911-1921. doi: 10.2147/CMAR.S363235. eCollection 2022.
The aim of this study was to evaluate treatment responses, toxicity, and survival among cHL patients aged ≥50 years.
We retrospectively identified all newly diagnosed cHL patients and only included cases who were ≥50 years old at the time of diagnosis and with data available between 1999 and 2020.
There were 101 patients, of which 52 were between 50 and 59 years of age, and 49 patients were ≥60 years old. Sixty-two patients were male, and the most common histopathological subtype was mixed cellularity cHL (58.4%). ECOG PS, CCI, CIRS, and ACE-27 scores were significantly higher in patients aged ≥60 years than those of 50-59 age group. While all patients aged 50-59 years received ABVD as first-line therapy, 79% (n=39) of cases aged ≥60 years had ABVD. In patients receiving ABVD, 95% and 92.7% of the cases aged 50-59 and ≥60 years had CR, respectively (=0.999). Age groups were comparable in terms of hematological and non-hematological toxicities (=0.369, =0.127, respectively). Although not statistically significant, median survival was longer in patients receiving a transplant than in those without transplantation (108 months vs 52 months, =0.069). In multivariate analysis, the risk of progression was higher in patients with lymphocyte ≤600/mm and in those who were unresponsive to first-line therapy (=0.002 and <0.001, respectively). Patients with B symptoms, age ≥60 years, and CIRS >3 had higher risk of mortality (=0.001, =0.012, =0.038, respectively). By using these 3 parameters, we defined a new risk score, which divided our patient cohort into two as low- and high-risk groups. Low-risk patients had significantly higher survival rates than the high-risk group (83.9% vs 40.5%, <0.001).
This new prognostic score should be further tested and validated in other patient populations. Although our study has some limitations including the limited number of patients and its retrospective nature, there are not so many studies in elderly cHL patients and elderly and/or frail patients are generally excluded in most of the clinical trials. Thus, this real-life single-center experience would contribute to the literature.
本研究的目的是评估年龄≥50岁的经典型霍奇金淋巴瘤（cHL）患者的治疗反应、毒性和生存率。
我们回顾性地确定了所有新诊断的cHL患者，仅纳入诊断时年龄≥50岁且在1999年至2020年期间有可用数据的病例。
共有101例患者，其中52例年龄在50至59岁之间，49例患者年龄≥60岁。62例为男性，最常见的组织病理学亚型是混合细胞型cHL（58.4%）。年龄≥60岁患者的东部肿瘤协作组体能状态（ECOG PS）、Charlson合并症指数（CCI）、累积疾病评分量表（CIRS）和ACE-27评分显著高于50-59岁年龄组的患者。虽然所有50-59岁的患者均接受阿霉素、博来霉素、长春新碱和达卡巴嗪（ABVD）作为一线治疗，但年龄≥60岁的病例中有79%（n = 39）接受了ABVD治疗。在接受ABVD治疗的患者中，年龄在50-59岁和≥60岁的病例分别有95%和92.7%达到完全缓解（CR）（P = 0.999）。各年龄组在血液学和非血液学毒性方面具有可比性（P分别为0.369和0.127）。虽然无统计学意义，但接受移植的患者的中位生存期长于未接受移植的患者（108个月对52个月，P = 0.069）。在多变量分析中，淋巴细胞≤600/mm³的患者和对一线治疗无反应的患者疾病进展风险更高（P分别为0.002和＜0.001）。有B症状、年龄≥60岁和CIRS＞3的患者死亡风险更高（P分别为0.001、0.012、0.038）。通过使用这3个参数，我们定义了一个新的风险评分，将我们的患者队列分为低风险和高风险两组。低风险患者的生存率显著高于高风险组（83.9%对40.5%，P＜0.001）。
这个新的预后评分应在其他患者群体中进一步测试和验证。虽然我们的研究有一些局限性，包括患者数量有限及其回顾性性质，但老年cHL患者的研究并不多，并且在大多数临床试验中通常排除老年和/或体弱患者。因此，这种真实世界的单中心经验将为文献做出贡献。
