A systematic review of therapeutic regimens for older patients with newly diagnosed Hodgkin lymphoma

Abstract

Classical Hodgkin lymphoma (cHL) in older adults is associated with inferior outcomes and increased toxicity compared to younger patients. Novel therapies like brentuximab vedotin (BV) have yielded promising results, yet their optimal use in older cHL remains unclear. We performed a systematic review to assess outcomes and toxicity associated with frontline regimens in older cHL. We screened 196 references involving chemotherapy without BV and 662 references containing BV and included 9 studies (12 arms) without BV and 6 studies (7 arms) with BV. Progression-free survival (PFS) ranged from 47 to 84% at 2 years in BV-containing arms and 42–79% at 5 years in non-BV containing trials. Pulmonary toxicity was more common in arms receiving >2 cycles of bleomycin, whereas peripheral neuropathy was associated with cumulative BV dose. This review summarizes available treatment outcomes in newly diagnosed older cHL patients and may aid clinicians in decision-making regarding available frontline approaches.

Key Points

• This systematic review suggests that >2 cycles of bleomycin is associated with excess pulmonary toxicity in cHL patients older than 60 years of age.

• Peripheral neuropathy was more frequent in patients receiving BV-containing regimens and was associated with cumulative BV dose.

• BV-containing regimens are associated with high response rates in advanced-stage patients, but follow-up is limited.

Keywords:

• Classical Hodgkin lymphoma
• elderly
• brentuximab vedotin
• treatment
• newly diagnosed

Disclosure statement

PA participated in advisory boards for Bayer and Imbrium; AE participated in advisory boards for Seattle Genetics, Bayer, Verastem, Pharmacyclics, Takeda, and Merck. CF reports personal fees from Abbvie, AstraZeneca, Bayer, BeiGene, Celgene, Denovo Biopharma, Gilead, OptumRx, Karyopharm, Pharmacyclics/Janssen, Spectrum, grants from Abbvie, Acerta, BeiGene, Celgene, Gilead, Genentech/Roche, Janssen Pharmaceutical, Millennium/Takeda, Pharmacyclics, TG Therapeutics, Burroughs Wellcome Fund, Eastern Cooperative Oncology Group, National Cancer Institute, and the V Foundation, NIH, outside the submitted work.