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Four-cycle ABVD unsuitable for older patients with Hodgkin’s lymphoma
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Four cycles of treatment with doxorubicin, bleomycin, vinblastine and dacarbazine led to a significant dose reduction, delay in treatment, toxicity and treatment-associated mortality among patients aged at least 60 years with early-stage Hodgkin’s lymphoma, according to study results.
Although doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) is the known standard of care in older patients with Hodgkin’s lymphoma, data are needed on the safety and efficacy of the chemotherapy among this patient population.
Boris Böll, MD, of the Laboratory of Immunotherapy in the department of hematology and oncology at the University Hospital Cologne in Germany, and colleagues set out to assess the use of four cycles of ABVD in 1,299 patients aged 60 to 75 years with early-stage Hodgkin’s lymphoma included in the German Hodgkin Study Group HD10 and HD11 trials.
Results then were compared with data from younger patients included in both trials.
Eighty-nine percent of older patients achieved complete response, 11% relapsed and 3% had progressive disease. At 92-month follow-up, death occurred in 28% of patients. Five-year PFS was about 75% (95% CI, 66-82).
Excessive toxicity from treatment was associated with treatment not being administered as per protocol in 14% of older patients. In addition, mean treatment delay was nearly twice as high among older patients when compared with younger patients (2.2 weeks vs. 1.2 weeks).
Andrew M. Evens
A relative dose-intensity of at least 80% was achieved in 59% of older patients vs. 85% of younger patients. WHO grade 3 and 4 toxicity (leucopenia, nausea and infection) was observed in 68% of older patients, with a 5% treatment-associated mortality.
“Although it is challenging to do so, clinical trials should be designed to allow real-time flexibility to modify dosing and/or regimens on the basis of objective criteria that predict prohibitive morbidity and mortality,” Andrew M. Evens, MD, of the University of Massachusetts Medical School and University of Massachusetts Memorial Cancer Center, and Fangxin Hong, MD, of Dana-Farber Cancer Institute and the Harvard School of Public Health, wrote in an accompanying editorial. “Altogether, multicenter collaborations that integrate novel agents and incorporate formal assessments of functional status to tailor therapy on a patient-specific basis will be critical to the successful study of and improved outcomes for older patients with Hodgkin’s lymphoma.”
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