Prognostic Score Predicts Overall Survival in Older Patients With Hodgkin Lymphoma by Second-Line Treatment Strategy
In a study reported in the Journal of Clinical Oncology, Boris Böll, MD, of University Hospital Cologne, and colleagues analyzed second-line treatment and survival in older patients with relapsed/refractory Hodgkin lymphoma in German Hodgkin Study Group first-line studies. Use of a prognostic score to divide patients into low-risk and high-risk groups showed that overall survival was significantly prolonged by conventional polychemotherapy/salvage radiotherapy approaches in low-risk patients and that no second-line strategy was associated with overall survival benefit in high-risk patients.
Study Details
The study involved patients aged ≥ 60 years receiving first-line treatment in German Hodgkin Study Group studies between 1993 and 2007 who subsequently received second-line treatment for refractory or relapsed disease. A total of 105 patients (median age, 66 years) were identified, 28% with progressive disease, 31% with early relapse, and 41% with late relapse after first-line treatment. Second-line treatments were intensified salvage regimens in 22%, conventional polychemotherapy and/or salvage radiotherapy with curative intent in 42%, and palliative treatment in 31%. Median overall survival for all patients was 12 months, and 3-year overall survival was 31%.
High vs Low Risk
An established prognostic score for relapsed/refractory disease was used to categorize patients into low-risk or high-risk groups. The score is based on presence of early relapse (< 12 months from end of first-line treatment), clinical stage III or IV at relapse, and anemia (hemoglobin > 10.5 g/dL in women and < 12.0 g/dL in men). Patients with more than one risk factor were considered high risk. Median overall survival was 45 months in low-risk patients and 9 months in high-risk patients, and 3-year overall survival was 59% and 9%, respectively.
Median overall survival was 10, 41, and 7 months for patients receiving intensified salvage regimens, polychemotherapy and/or salvage radiotherapy, and palliative treatment, respectively. Since 30% of patients receiving polychemotherapy and/or salvage radiotherapy were considered high risk compared with 74% and 65% of patients receiving intensified salvage treatment or palliative treatment, respectively, a multivariate analysis including risk group and second-line treatment strategy was performed. The analysis showed that high risk (hazard ratio [HR] = 3.17, P < .001), intensified-regimen treatment (HR = 2.51, P =.008), and palliative treatment (HR = 3.25, P < .001) were still significantly associated with poorer survival, indicating that the benefit of the polychemotherapy and/or salvage radiotherapy approach remained after adjustment for risk profile.
Benefit of Polychemotherapy/Salvage Radiotherapy
Analysis of the interaction of risk group and treatment strategy showed that among low-risk patients, median overall survival was 61 months in the polychemotherapy and/or salvage radiotherapy group compared with 6 months in the intensified salvage treatment group and 9 months in the palliative treatment group (P < .001). Among high-risk patients, median overall survival was short in all groups, with no differences among groups.
The investigators concluded, “[Overall survival] in older patients with relapsed/refractory Hodgkin lymphoma can be predicted using a simple prognostic score. Poor outcome in high-risk patients cannot be overcome by any of the applied treatment strategies. Our results might help to guide treatment decisions and evaluate new compounds in these patients.”
The study was supported by the Deutsche Krebshilfe and Deutsche Forschungsgemeinschaft.
Peter Borchmann, MD, of University Hospital of Cologne, is the corresponding author for the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
