Age, anthracycline and mortality in 28,000 classic Hodgkin lymphoma patients: cohort study of a complete population

Abstract

Classic Hodgkin lymphoma (CHL) has an excellent prognosis in younger patients but outcomes are poorer in those aged ≥60 years at diagnosis. We used routinely collected English data to assess baseline characteristics, survival and treatment approaches in 28 175 patients with CHL registered between 1997 and 2020 with a particular focus on 1 958 patients aged 60 to 79 years at diagnosis with known first-line chemotherapy regimens. Mortality rates (all causes, lymphoma-specific and other causes) were calculated first without and then with adjustment for available characteristics to identify factors associated with survival.

Survival outcomes for younger patients were better than older (p<0.001) and lymphomaspecific mortality for all patients <80 years at diagnosis has improved in recent calendar years (p<0.001). Fewer comorbidities and better performance status were associated with better lymphoma-specific survival in older patients (p<0.001). Chemotherapeutic approaches in those aged 60-79 years at diagnosis were heterogenous and the most common regimens, in order, were ABVD, AVD, ChlVPP, VEPEMB, CHOP and single-agent treatments. Lymphomaspecific mortality rates varied substantially between these regimens even following adjustment for known characteristics (p<0.001), with ABVD and AVD having better outcomes than other regimens. Anthracycline use was strongly associated with increased lymphoma-specific survival (p<0.001) and geographical regions where fewer patients were prescribed anthracycline had poorer lymphoma-specific survival (p=0.002).

The findings from this large dataset clearly indicate the importance of anthracycline prescription where possible for older CHL patients, with use of ABVD/AVD preferred over CHOP or VEPEMB. Patients should be carefully optimised prior to commencement of chemotherapy.