Park Chung Hyun, Cho Hyunsoo, Kim Soo-Jeong
Blood Cancer Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
Division of Hematology and Oncology, Department of Internal Medicine, Yongin Severance Hospital, Yongin-si, Gyeonggi-do, 16995, Republic of Korea.
Blood Res. 2025 Jun 12;60(1):35. doi: 10.1007/s44313-025-00084-4.
Older patients with classic Hodgkin lymphoma (HL) often experience poor outcomes due to age-related comorbidities and treatment-related toxicity. Comprehensive geriatric assessment and supportive care measures, including pre-phase corticosteroids, growth factor prophylaxis, and organ function monitoring, are essential for optimizing treatment tolerance in this vulnerable patient population. Recent phase III trial (S1826) demonstrated that nivolumab plus doxorubicin, vinblastine, and dacarbazine (Nivo + AVD) significantly improves progression-free survival and is better tolerated than brentuximab vedotin (BV) + AVD, particularly in patients over 60 years of age. Given its efficacy and reduced toxicity, Nivo + AVD is likely to become a key treatment option for fit older patients with HL. For frail patients, chemo-free approaches with BV and checkpoint inhibitors remain viable alternatives. Future research should refine fitness-based treatment strategies, integrate novel agents, and enhance supportive care to improve outcomes and minimize treatment-related toxicity in this population.
老年经典型霍奇金淋巴瘤（HL）患者常因年龄相关的合并症和治疗相关毒性而预后不佳。全面的老年综合评估和支持性护理措施，包括预处理期使用皮质类固醇、生长因子预防和器官功能监测，对于优化这一脆弱患者群体的治疗耐受性至关重要。近期的III期试验（S1826）表明，纳武单抗联合多柔比星、长春花碱和达卡巴嗪（Nivo + AVD）显著改善无进展生存期，且耐受性优于 Brentuximab vedotin（BV）+ AVD，尤其是在60岁以上的患者中。鉴于其疗效和较低的毒性，Nivo + AVD可能成为适合的老年HL患者的关键治疗选择。对于体弱患者，使用BV和检查点抑制剂的无化疗方法仍是可行的替代方案。未来的研究应完善基于健康状况的治疗策略，整合新型药物，并加强支持性护理，以改善这一人群的预后并将治疗相关毒性降至最低。
