Hodgkin's disease in the elderly: improved treatment outcome with a doxorubicin-containing regimen.

Abstract

PURPOSE:

Hodgkin's disease (HD) is a malignancy that displays a bimodal age distribution. Previous reports of treatment in patients greater-than-or-equal 60 years have found a poor outcome, particularly in patients with advanced disease. Because of an improved side-effect profile, the regimen of chlorambucil, vinblastine, procarbazine, and prednisone (ChlVPP) has been proposed for use in elderly patients.

PATIENTS AND METHODS:

From September 1982 to May 1998, 262 patients with previously untreated HD received either ChlVPP (n = 176) or ChlVPP plus doxorubicin/bleomycin/vincristine (ChlVPP/ABV hybrid; n = 86). Fifty-six patients were greater-than-or-equal 60 years old, and 206 were younger than 60 years.

RESULTS:

The 5-year overall survival (OS; 87% v 39%) and the 5-year event-free survival (EFS; 75% v 31%) favored patients younger than 60 years of age. Prognostic factors analyzed in patients greater-than-or-equal 60 years of age, other than type of therapy, included sex, stage, Karnofsky performance score, lactic dehydrogenase, number of extranodal sites, B symptoms, size of largest mass, and histologic subtype. In patients older than 60 years, none of the clinical features was a statistically significant predictor of EFS; however, ChlVPP/ABV hybrid was associated with a decreased risk of an event (relative risk, 0.40; 95% confidence interval, 0.19 to 0.83; P =.014) compared with ChlVPP. The 5-year OS for patients greater-than-or-equal 60 years who received ChlVPP was 30%, compared with 67% for those patients receiving the ChlVPP/ABV regimen (P =.0086)

CONCLUSION:

Patients greater-than-or-equal 60 years with HD who require chemotherapy are better treated with ChlVPP/ABV hybrid than with ChlVPP alone.

• Authors: Colin D Weekes, Julie M Vose, Jim C Lynch, Dennis D Weisenburger, Philip J Bierman, Timothy Greiner, Gregory Bociek, Charles Enke, Martin Bast, Wing C Chan, James O Armitage, Nebraska Lymphoma Study Group
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 20 Issue 4 Pg. 1087-93 (Feb 15 2002) ISSN: 0732-183X [Print] United States
• PMID: 11844834 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Bleomycin
• Chlorambucil
• Procarbazine
• Vinblastine
• Doxorubicin
• Prednisolone

Topics

• Age Factors
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
• Bleomycin (administration & dosage)
• Chlorambucil (administration & dosage)
• Disease-Free Survival
• Doxorubicin (administration & dosage)
• Female
• Hodgkin Disease (drug therapy, pathology)
• Humans
• Male
• Middle Aged
• Prednisolone (administration & dosage)
• Procarbazine (administration & dosage)
• Risk Factors
• Treatment Outcome
• Vinblastine (administration & dosage)