title: Relapsed hodgkin lymphoma in older patients: a comprehensive analysis from the German hodgkin study group.
abstract: OBJECTIVE
  Progression or relapse of Hodgkin lymphoma (HL) is common among older patients. However, prognosis and effects of second-line treatment are thus far unknown.
  
  
  METHODS
  We investigated second-line treatment and survival in older patients with progressive or relapsed HL. Patients treated within German Hodgkin Study Group first-line studies between 1993 and 2007 were screened for refractory disease or relapse (RR-HL). Patients with RR-HL age ≥ 60 years at first-line treatment were included in this analysis.
  
  
  RESULTS
  We identified 105 patients (median age, 66 years); 28%, 31%, and 41% had progressive disease, early relapse, or late relapse, respectively. Second-line treatment strategies included intensified salvage regimens (22%), conventional polychemotherapy and/or salvage-radiotherapy with curative intent (42%), and palliative approaches (31%). Median overall survival (OS) for the entire cohort was 12 months; OS at 3 years was 31% (95% CI, 22% to 40%). A prognostic score with risk factors (RFs) of early relapse, clinical stage III/IV, and anemia identified patients with favorable and unfavorable prognosis (≤ one RF: 3-year OS, 59%; 95% CI, 44% to 74%; ≥ two RFs: 3-year OS, 9%; 95% CI, 1% to 18%). In low-risk patients, the impact of therapy on survival was significant in favor of the conventional polychemotherapy/salvage radiotherapy approach. In high-risk patients, OS was low overall and did not differ significantly among treatment strategies.
  
  
  CONCLUSIONS
  OS in older patients with RR-HL can be predicted using a simple prognostic score. Poor outcome in high-risk patients cannot be overcome by any of the applied treatment strategies. Our results might help to guide treatment decisions and evaluate new compounds in these patients.
authors.affiliation: Boris Böll, Bastian von Tresckow, Dennis A. Eichenauer, Stephanie Sasse, Michael Fuchs, Karolin Behringer, Beate C. Klimm, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Bastian von Tresckow, Dennis A. Eichenauer, Stephanie Sasse, Michael Fuchs, Karolin Behringer, Beate C. Klimm, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Nils Arndt and Ralph Naumann, Stiftungsklinikum Mittelrhein, Koblenz; Julia Meissner, Heidelberg University Hospital, Heidelberg; Stefan W. Krause, Erlangen University Hospital, Erlangen; and Roland Schnell, Pioh Medical Oncology and Hematology, Frechen, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Böll
authors.forename: Helen
authors.initials: H
authors.lastname: Goergen
authors.forename: Nils
authors.initials: N
authors.lastname: Arndt
authors.forename: Julia
authors.initials: J
authors.lastname: Meissner
authors.forename: Stefan W
authors.initials: SW
authors.lastname: Krause
authors.forename: Roland
authors.initials: R
authors.lastname: Schnell
authors.forename: Bastian
authors.initials: B
authors.lastname: von Tresckow
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Eichenauer
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sasse
authors.forename: Michael
authors.initials: M
authors.lastname: Fuchs
authors.forename: Karolin
authors.initials: K
authors.lastname: Behringer
authors.forename: Beate C
authors.initials: BC
authors.lastname: Klimm
authors.forename: Ralph
authors.initials: R
authors.lastname: Naumann
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.forename: Peter
authors.initials: P
authors.lastname: Borchmann
mesh_terms: D000368:Aged; D002423:Cause of Death; D059248:Chemoradiotherapy; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005858:Germany; D006689:Hodgkin Disease / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*