title: Hodgkin's lymphoma in elderly patients: a comprehensive retrospective analysis from the German Hodgkin's Study Group.
abstract: OBJECTIVE
  With improved prognosis for patients with Hodgkin's lymphoma (HL), interest increasingly focuses on high-risk groups such as elderly patients. We thus performed a retrospective analysis using the German Hodgkin's Study Group (GHSG) database to determine clinical risk factors, course of treatment, and outcome in elderly HL patients in comparison with younger adults.
  
  
  METHODS
  A total of 4,251 patients included in the GHSG studies HD5 to HD9 were analyzed, of whom 372 (8.8%) were 60 years or older and 3,879 (91.2%) were younger than 60 years. Patient characteristics, treatment results, toxicity, freedom from treatment failure (FFTF), and overall survival (OS) were compared.
  
  
  RESULTS
  Elderly patients more often had mixed cellularity subtype, "B" symptoms, elevated erythrocyte sedimentation rate, and poorer performance status. Less frequently observed were nodular sclerosis subtype, large mediastinal mass, and bulky disease. Acute toxicity during chemotherapy was generally higher in elderly patients. This was most obvious for severe infections (grade 3 or 4; 15% v 6%) correlating with more severe leukopenia in elderly patients (grade 4; 38% v 23%). As a result, significantly fewer elderly patients received the intended full chemotherapy dose (75% v 91%). The survival analysis showed a significantly poorer treatment outcome for elderly patients in terms of 5-year OS (65% v 90%), FFTF (60% v 80%), and HL-specific FFTF (73% v 82%).
  
  
  CONCLUSIONS
  Elderly patients have a poorer risk profile compared with younger HL patients and experience more severe treatment-associated toxicity. Higher mortality during treatment as well as lower dose-intensity are the major factors explaining the poorer overall outcome of elderly HL patients.
authors.affiliation: Department of Internal Medicine, University of Cologne, Kerpener Str 62, 50924 Cologne, Germany. a.engert@uni-koeln.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.forename: Veronika
authors.initials: V
authors.lastname: Ballova
authors.forename: Heinz
authors.initials: H
authors.lastname: Haverkamp
authors.forename: Beate
authors.initials: B
authors.lastname: Pfistner
authors.forename: Andreas
authors.initials: A
authors.lastname: Josting
authors.forename: Eckhart
authors.initials: E
authors.lastname: Dühmke
authors.forename: Konrad
authors.initials: K
authors.lastname: Müller-Hermelink
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003131:Combined Modality Therapy; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis