title: Evaluation of treatment outcome in 175 patients with Hodgkin lymphoma aged 60 years or over: the SHIELD study.
abstract: The SHIELD program for Hodgkin lymphoma in patients 60 years of age or older, prospectively evaluated clinical features and outcome in a large patient cohort (n = 175). The central element was a phase 2 study of VEPEMB chemotherapy (n = 103, median age 73 years) incorporating comorbidity assessment. A total of 72 other patients were treated off-study but registered prospectively and treated concurrently with: ABVD (n = 35); CLVPP (n = 19), or other (n = 18). Of VEPEMB patients, 31 had early-stage disease (stage 1A/2A) and received VEPEMB 3 times plus radiotherapy. Median follow-up was 36 months. Complete remission (CR) rate (intention-to-treat) was 74% and 3-year overall survival (OS) and progression-free survival (PFS) were 81% and 74%, respectively. A total of 72 patients had advanced-stage disease (stage 1B/2B/3 or 4) and received VEPEMB 6 times. CR rate was 61% with 3-year OS and PFS of 66% and 58%, respectively. Of patients achieving CR, 13% with early-stage and 5% with advanced-stage disease progressed. Overall treatment-related mortality was 7%. In patients treated with curative intent with VEPEMB, ABVD, and CLVPP (n = 157), CR linked to several factors in univariate analysis. In a Cox regression model only, obtaining CR remained significant for OS and CR plus comorbidity and age for PFS. RS-EBV status had no significant effect on outcome.
authors.affiliation: Academic Haematology, Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom. s.j.proctor@newcastle.ac.uk
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Proctor
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wilkinson
authors.forename: Gail
authors.initials: G
authors.lastname: Jones
authors.forename: Gillian C
authors.initials: GC
authors.lastname: Watson
authors.forename: Helen H
authors.initials: HH
authors.lastname: Lucraft
authors.forename: Tryfonia
authors.initials: T
authors.lastname: Mainou-Fowler
authors.forename: Dominic
authors.initials: D
authors.lastname: Culligan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Galloway
authors.forename: Katrina M
authors.initials: KM
authors.lastname: Wood
authors.forename: Richard J Q
authors.initials: RJ
authors.lastname: McNally
authors.forename: Peter W
authors.initials: PW
authors.lastname: James
authors.forename: John R
authors.initials: JR
authors.lastname: Goodlad
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017322:Clinical Trials, Phase II as Topic / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome