Hodgkin's disease in the elderly: improved treatment outcome with a doxorubicin-containing regimen.
OBJECTIVE
Hodgkin's disease (HD) is a malignancy that displays a bimodal age distribution. Previous reports of treatment in patients greater-than-or-equal 60 years have found a poor outcome, particularly in patients with advanced disease. Because of an improved side-effect profile, the regimen of chlorambucil, vinblastine, procarbazine, and prednisone (ChlVPP) has been proposed for use in elderly patients.


METHODS
From September 1982 to May 1998, 262 patients with previously untreated HD received either ChlVPP (n = 176) or ChlVPP plus doxorubicin/bleomycin/vincristine (ChlVPP/ABV hybrid; n = 86). Fifty-six patients were greater-than-or-equal 60 years old, and 206 were younger than 60 years.


RESULTS
The 5-year overall survival (OS; 87% v 39%) and the 5-year event-free survival (EFS; 75% v 31%) favored patients younger than 60 years of age. Prognostic factors analyzed in patients greater-than-or-equal 60 years of age, other than type of therapy, included sex, stage, Karnofsky performance score, lactic dehydrogenase, number of extranodal sites, B symptoms, size of largest mass, and histologic subtype. In patients older than 60 years, none of the clinical features was a statistically significant predictor of EFS; however, ChlVPP/ABV hybrid was associated with a decreased risk of an event (relative risk, 0.40; 95% confidence interval, 0.19 to 0.83; P =.014) compared with ChlVPP. The 5-year OS for patients greater-than-or-equal 60 years who received ChlVPP was 30%, compared with 67% for those patients receiving the ChlVPP/ABV regimen (P =.0086)


CONCLUSIONS
Patients greater-than-or-equal 60 years with HD who require chemotherapy are better treated with ChlVPP/ABV hybrid than with ChlVPP alone.
Weekes
Colin D
CD
University of Nebraska Medical Center, Omaha, NE 68198-7680, USA. jmvose@unmc.edu
Vose
Julie M
JM
Lynch
Jim C
JC
Weisenburger
Dennis D
DD
Bierman
Philip J
PJ
Greiner
Timothy
T
Bociek
Gregory
G
Enke
Charles
C
Bast
Martin
M
Chan
Wing C
WC
Armitage
James O
JO
D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002699:Chlorambucil / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D012307:Risk Factors; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
D001761:Bleomycin; D002699:Chlorambucil; D011344:Procarbazine; D014747:Vinblastine; D004317:Doxorubicin; D011239:Prednisolone