Treatment Responses, Toxicity, and Survival in Patients with Classical Hodgkin Lymphoma Aged ≥50 Years: A Single-Center Experience Over Two Decades

Figures & data

Table 1 Demographic and Clinical Characteristics of All Patients and the Different Patient Groups

Parameter	All Patients		50–59 Years		≥60 Years		p value
	N	%	N	%	N	%
All patients	101	100	52	51.5	49	48.5
Age, years
Median (range)	59 (50–85)		53 (50–59)		66 (60–85)		^a<0.001
Follow-up time, months
Median (range)	57 (1–264)		71.5 (3–264)		47 (1–180)		^a0.017
Sex
Female	39	38.6	14	26.9	25	51	^b0.013
Male	62	61.4	38	73.1	24	49
Histopathological subtype
Nodular sclerosis	21	20.8	9	17.3	12	24.5	^c0.634
Mixed cellularity	59	58.4	32	61.5	27	55.1
Lymphocyte predominant	5	5	3	5.8	2	4.1
Lymphocyte depleted	2	2	0	0	2	4.1
Not specified	14	13.9	8	15.4	6	12.2
Stage
Early-stage favorable	16	15.8	10	19.2	6	12.2	^b0.367
Early-stage unfavorable	31	30.7	13	25.0	18	36.7
Advanced stage	54	53.5	29	55.8	25	51
B symptoms present	61	60.4	34	65.4	27	55.1	^b0.291
Comorbidities present	66	65.3	25	48.1	41	83.7	^b<0.001

Note: (^aIndependent groups t-test, ^bPearson chi-square test, ^cFisher-Freeman-Halton exact test). P values marked with bold indicate statistically significant differences between groups.

Table 2 Different Scoring Systems in the Entire Patient Cohort and Two Age Groups

Parameter	All Patients		50–59 Years		≥60 Years		p value
	N	%	N	%	N	%
ACE-27
2	83	82.2	48	92.3	35	71.4	^a0.006
3	18	17.8	4	7.7	14	28.6
CCI
1	43	42.6	43	82.6	0	0	^a<0.001
≥2	58	57.4	9	17.4	49	100
CIRS
≤3	79	78.2	45	86.5	34	69.4	^a0.037
>3	22	21.8	7	13.5	15	30.6
ECOG PS
0–2	94	95.9	51	100	43	91.5	^b0.049
3–4	4	4.1	0	0	4	8.5

Note: (^aPearson chi-square test, ^bFisher’s exact test). P values marked with bold indicate statistically significant differences between groups.

Abbreviations: ACE-27, Adult Comorbidity Evaluation-27; CCI, Charlson Comorbidity Index; CIRS, Cumulative Disease Rating Score; ECOG, Eastern Cooperative Oncology Group; PS, performance scale).

Figure 1 Progression-free survival (PFS) according to lymphocyte counts (A), EOT response (B) (EOT, end of treatment).

Figure 2 Overall survival (OS) according to age (A), B symptoms (B), Cumulative Disease Rating Score (CIRS) (C).

Table 3 Univariate and Multivariate Cox Regression Analysis for PFS

PFS	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	p value	HR (95% CI)	p value
Histopathological subtype		0.021		Eliminated
Nodular sclerosis	3.561 (1.192, 10.640)	0.023
Mixed cellularity	1 (Reference)
Lymphocyte predominant	9.368 (1.801, 48.718)	0.008
Lymphocyte depleted	12.252 (1.354, 110.903)	0.026
Not specified	1.659 (0.412, 6.676)	0.476
B symptoms		0.070
Present	1 (Reference)			–
None	2.781 (0.919, 8.416)
Lymphocyte count		0.001		0.002
≤600/mm^3	8.514 (2.296, 31.565)		8.973 (2.308, 34.893)
>600/mm^3	1 (Reference)		1 (Reference)
Interim response evaluation		0.121
Un-responsive	2.212 (0.810, 6.039)			-
Responsive	1 (Reference)
EOT response evaluation		<0.001		<0.001
Un-responsive	11.477 (3.510, 37.526)		12.360 (3.625, 42.144)
Responsive	1 (Reference)		1 (Reference)

Note: P values marked with bold indicate statistically significant differences between groups.

Abbreviations: HR, hazard ratio; 95% CI, confidence intervals; PFS, progression-free survival; EOT, end-of-treatment.

Table 4 Univariate and Multivariate Cox Regression Analysis for OS

OS	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	p value	HR (95% CI)	p value
Age		0.001		0.001
50–59 years	1 (Reference)		1 (Reference)
≥ 60 years	3.424 (1.612, 7.272)		3.711 (1.698, 8.112)
B symptoms		0.049		0.012
None	1 (Reference)		1 (Reference)
Present	2.333 (1.004, 5.421)		2.987 (1.269, 7.030)
IPS-7		0.264
0–3	1 (Reference)			-
4–7	1.523 (0.728, 3.184)
IPS-7		0.116
0–2	1 (Reference)
3–4	2.192 (0.962, 4.993)	0.062		-
5–7	0.690 (0.086, 5.524)	0.726
CCI		0.011		Eliminated
1	1 (Reference)
≥2	2.752 (1.265, 5.988)
CIRS		0.005		0.038
≤3	1 (Reference)		1 (Reference)
>3	3.174 (1.426, 7.064)		2.357 (1.048, 5.297)
ECOG PS		0.004		Eliminated
0–2	1 (Reference)
3–4	6.143 (1.801, 20.956)
Lymphocyte count		0.075
≤600/mm^3	2.620 (0.907, 7.570)			-
>600/mm^3	1 (Reference)
Liver involvement		0.226
Yes	1 (Reference)			-
No	1.647 (0.734, 3.694)
Interim response evaluation		0.070
Un-responsive	2.186 (0.937, 5.102)			-
Responsive	1 (Reference)

Note: P values marked with bold indicate statistically significant differences between groups.

Abbreviations: HR, hazard ratio; 95% CI, confidence intervals; OS, overall survival; IPS, International Prognostic Score; CCI, Charlson Comorbidity Index; CIRS, Cumulative Disease Rating Score; ECOG, Eastern Cooperative Oncology Group; PS, performance scale).

Figure 3 OS according to new survival score groups.