University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD).
German Hodgkin Study Group (GHSG).
Curr Opin Oncol. 2024 Sep 1;36(5):353-359. doi: 10.1097/CCO.0000000000001071. Epub 2024 Jun 20.
Hodgkin lymphoma (HL) occurs at two age peaks around 25 and 60 years of age. Due to varying fitness and co-morbidities older patients are a heterogeneous group that has relatively poor treatment outcomes. The evolving therapeutic landscape for older HL is summarized herein.
Due to lack of data from larger trials and approval of novel drugs, first-line treatment of limited-stage HL (i.e. early-stage favourable and unfavourable) remains largely A(B)VD and radiotherapy based. For patients with advanced-stage HL, the anti-CD30 antibody-drug conjugate brentuximab vedotin is approved in combination with AVD chemotherapy (BV-AVD). Due to toxicities such as febrile neutropenia or polyneuropathy and lack of improvement in progression-free and overall survival in the older subgroup, fully concomitant BV-AVD is however not used widely. More recently, promising early data was reported with the combination of nivolumab and AVD (N-AVD) in patients >60 years with advanced-stage HL. Second-line treatment depends on fitness and might include high-dose chemotherapy and autologous stem-cell transplantation for selected patients. For unfit or multiply relapsed patients, anti-PD1 antibodies are the preferred treatment option.
The increasing number of older HL patients constitutes a therapeutic challenge despite recent advances and the increased usage of targeted agents.
霍奇金淋巴瘤（HL）在 25 岁和 60 岁左右出现两个发病高峰。由于体能和合并症的不同，老年 HL 患者是一个异质性群体，治疗效果相对较差。本文总结了老年 HL 不断发展的治疗前景。
由于缺乏来自大型试验的数据和新型药物的批准，局限性 HL（即早期有利和不利）的一线治疗仍然主要基于 A（B）VD 和放疗。对于晚期 HL 患者，抗 CD30 抗体药物偶联物 Brentuximab vedotin 与 AVD 化疗（BV-AVD）联合获批。由于发热性中性粒细胞减少症或多发性神经病等毒性作用，以及在老年亚组中无进展生存期和总生存期的改善，完全同时使用 BV-AVD 并不广泛。最近，在晚期 HL 患者中，nivolumab 和 AVD（N-AVD）联合治疗的早期数据令人鼓舞。二线治疗取决于体能状况，可能包括高剂量化疗和自体干细胞移植，适用于选定的患者。对于不适合或多次复发的患者，抗 PD1 抗体是首选的治疗选择。
尽管最近取得了进展，靶向药物的应用也有所增加，但越来越多的老年 HL 患者仍构成治疗挑战。
