title: Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly.
abstract: There is no standard of care in elderly classical Hodgkin lymphoma (cHL) patients. ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), the standard chemotherapy for younger patients, is also used in elderly patients but little is known about toxicity and efficacy. We retrospectively analysed 147 patients aged 60 years and over treated with ABVD in three French haematological centres. Treatment regimen modification was applied in 56 patients for toxicity or HL progression. Bleomycin was removed or reduced in 53 patients, mainly for pulmonary toxicity. Neither initial characteristics nor treatment characteristics were found to correlate with lung toxicity. One hundred and seventeen patients achieved a complete remission, 6 a partial remission, 16 had refractory disease and 8 were non-evaluable. Five-year overall survival was estimated at 67%. With a median follow-up of 58 months, 51 patients died and 14% of deaths were related to lung toxicity. Our study confirms the efficacy of ABVD in elderly patients even if results are inferior to those obtained in younger patients with the same regimen. ABVD can be proposed as front-line chemotherapy in selected elderly cHL patients. The frequency of pulmonary events leads us to propose to either reduce the dose of bleomycin or to remove it from the regimen.
authors.affiliation: Henri Becquerel Centre, Rouen University, Rouen, France.
authors.forename: Aspasia
authors.initials: A
authors.lastname: Stamatoullas
authors.affiliation: Saint Louis Hospital, Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Brice
authors.affiliation: Paoli Calmette Institute, Marseille, France.
authors.forename: Reda
authors.initials: R
authors.lastname: Bouabdallah
authors.affiliation: Henri Becquerel Centre, INSERM U918, Rouen, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Mareschal
authors.affiliation: Henri Becquerel Centre, Rouen University, Rouen, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Camus
authors.affiliation: Paoli Calmette Institute, Marseille, France.
authors.forename: Ilhem
authors.initials: I
authors.lastname: Rahal
authors.affiliation: Saint Louis Hospital, Paris, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Franchi
authors.affiliation: Henri Becquerel Centre, Rouen University, Rouen, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Lanic
authors.affiliation: Henri Becquerel Centre, Rouen University, Rouen, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Tilly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death; D003606:Dacarbazine / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D055370:Lung Injury / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin
keywords: Hodgkin lymphoma; doxorubicin, bleomycin, vinblastine and dacarbazine; elderly; pulmonary toxicity