Treatment Patterns and Outcomes in Early-stage Hodgkin Lymphoma in the Elderly

A National Cancer Database Analysis

Gaurav Goyal, Edward B. Maldonado, Tiffany J. Fan, Arun Kanmanthareddy, Peter T. Silberstein, Ronald S. Go, James O. Armitage

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The outcome for early-stage (I/II) Hodgkin lymphoma (HL) has improved significantly during the past few decades. However, older age (≥ 60 years) has continued to be associated with poor outcomes, and a paucity of data is available defining the optimal treatment regimens. In the present study, we sought to identify the practice patterns and outcomes in elderly patients with early-stage HL using the National Cancer Database. Materials and Methods: We performed a retrospective study of patients aged 60 years with early-stage classic HL diagnosed from 2004 to 2012. The overall survival (OS) of patients undergoing chemotherapy (CT), radiation therapy (RT), or CT plus RT were compared. Kaplan-Meier curves of OS for individual therapy were constructed and compared using the log-rank test. Multivariate analysis for predictors of mortality was conducted using the Cox proportional hazard method. Results: A total of 3795 patients were included in the analysis. At baseline, 41% patients had stage I disease. Of the 3795 patients, 51% underwent CT, 16% underwent RT, and 33% underwent CT plus RT. With a median follow-up duration of 40.4 months, the unadjusted OS rates for patients receiving CT, RT, or CT plus RT were 58.1%, 54%, and 77.7%, respectively (P < .0001). On multivariate analysis, CT plus RT improved OS compared with monotherapy. Conclusion: In older patients (age ≥ 60 years) with stage I/II HL, the combination of CT plus consolidative RT resulted in improved OS compared with monotherapy. However, the use of combination therapy in this age group seems suboptimal. This could be, in part, secondary to comorbidities limiting the use of CT plus RT in the elderly.

Original languageEnglish (US)
JournalClinical Lymphoma, Myeloma and Leukemia
DOIs
StateAccepted/In press - 2017

Fingerprint

Hodgkin Disease
Radiotherapy
Databases
Drug Therapy
Neoplasms
Survival
Multivariate Analysis
Kaplan-Meier Estimate
Combination Drug Therapy
Comorbidity
Therapeutics
Survival Rate
Retrospective Studies
Age Groups
Mortality

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Treatment Patterns and Outcomes in Early-stage Hodgkin Lymphoma in the Elderly : A National Cancer Database Analysis. / Goyal, Gaurav; Maldonado, Edward B.; Fan, Tiffany J.; Kanmanthareddy, Arun; Silberstein, Peter T.; Go, Ronald S.; Armitage, James O.

In: Clinical Lymphoma, Myeloma and Leukemia, 2017.

Research output: Contribution to journalArticle

Goyal, Gaurav ; Maldonado, Edward B. ; Fan, Tiffany J. ; Kanmanthareddy, Arun ; Silberstein, Peter T. ; Go, Ronald S. ; Armitage, James O. / Treatment Patterns and Outcomes in Early-stage Hodgkin Lymphoma in the Elderly : A National Cancer Database Analysis. In: Clinical Lymphoma, Myeloma and Leukemia. 2017.
@article{da638094f5ed4c648eae9d75f3f287fc,
title = "Treatment Patterns and Outcomes in Early-stage Hodgkin Lymphoma in the Elderly: A National Cancer Database Analysis",
abstract = "Background: The outcome for early-stage (I/II) Hodgkin lymphoma (HL) has improved significantly during the past few decades. However, older age (≥ 60 years) has continued to be associated with poor outcomes, and a paucity of data is available defining the optimal treatment regimens. In the present study, we sought to identify the practice patterns and outcomes in elderly patients with early-stage HL using the National Cancer Database. Materials and Methods: We performed a retrospective study of patients aged 60 years with early-stage classic HL diagnosed from 2004 to 2012. The overall survival (OS) of patients undergoing chemotherapy (CT), radiation therapy (RT), or CT plus RT were compared. Kaplan-Meier curves of OS for individual therapy were constructed and compared using the log-rank test. Multivariate analysis for predictors of mortality was conducted using the Cox proportional hazard method. Results: A total of 3795 patients were included in the analysis. At baseline, 41{\%} patients had stage I disease. Of the 3795 patients, 51{\%} underwent CT, 16{\%} underwent RT, and 33{\%} underwent CT plus RT. With a median follow-up duration of 40.4 months, the unadjusted OS rates for patients receiving CT, RT, or CT plus RT were 58.1{\%}, 54{\%}, and 77.7{\%}, respectively (P < .0001). On multivariate analysis, CT plus RT improved OS compared with monotherapy. Conclusion: In older patients (age ≥ 60 years) with stage I/II HL, the combination of CT plus consolidative RT resulted in improved OS compared with monotherapy. However, the use of combination therapy in this age group seems suboptimal. This could be, in part, secondary to comorbidities limiting the use of CT plus RT in the elderly.",
author = "Gaurav Goyal and Maldonado, {Edward B.} and Fan, {Tiffany J.} and Arun Kanmanthareddy and Silberstein, {Peter T.} and Go, {Ronald S.} and Armitage, {James O.}",
year = "2017",
doi = "10.1016/j.clml.2017.09.009",
language = "English (US)",
journal = "Clinical Lymphoma, Myeloma and Leukemia",
issn = "2152-2669",
publisher = "Cancer Media Group",

}

TY - JOUR

T1 - Treatment Patterns and Outcomes in Early-stage Hodgkin Lymphoma in the Elderly

T2 - A National Cancer Database Analysis

AU - Goyal, Gaurav

AU - Maldonado, Edward B.

AU - Fan, Tiffany J.

AU - Kanmanthareddy, Arun

AU - Silberstein, Peter T.

AU - Go, Ronald S.

AU - Armitage, James O.

PY - 2017

Y1 - 2017

N2 - Background: The outcome for early-stage (I/II) Hodgkin lymphoma (HL) has improved significantly during the past few decades. However, older age (≥ 60 years) has continued to be associated with poor outcomes, and a paucity of data is available defining the optimal treatment regimens. In the present study, we sought to identify the practice patterns and outcomes in elderly patients with early-stage HL using the National Cancer Database. Materials and Methods: We performed a retrospective study of patients aged 60 years with early-stage classic HL diagnosed from 2004 to 2012. The overall survival (OS) of patients undergoing chemotherapy (CT), radiation therapy (RT), or CT plus RT were compared. Kaplan-Meier curves of OS for individual therapy were constructed and compared using the log-rank test. Multivariate analysis for predictors of mortality was conducted using the Cox proportional hazard method. Results: A total of 3795 patients were included in the analysis. At baseline, 41% patients had stage I disease. Of the 3795 patients, 51% underwent CT, 16% underwent RT, and 33% underwent CT plus RT. With a median follow-up duration of 40.4 months, the unadjusted OS rates for patients receiving CT, RT, or CT plus RT were 58.1%, 54%, and 77.7%, respectively (P < .0001). On multivariate analysis, CT plus RT improved OS compared with monotherapy. Conclusion: In older patients (age ≥ 60 years) with stage I/II HL, the combination of CT plus consolidative RT resulted in improved OS compared with monotherapy. However, the use of combination therapy in this age group seems suboptimal. This could be, in part, secondary to comorbidities limiting the use of CT plus RT in the elderly.

AB - Background: The outcome for early-stage (I/II) Hodgkin lymphoma (HL) has improved significantly during the past few decades. However, older age (≥ 60 years) has continued to be associated with poor outcomes, and a paucity of data is available defining the optimal treatment regimens. In the present study, we sought to identify the practice patterns and outcomes in elderly patients with early-stage HL using the National Cancer Database. Materials and Methods: We performed a retrospective study of patients aged 60 years with early-stage classic HL diagnosed from 2004 to 2012. The overall survival (OS) of patients undergoing chemotherapy (CT), radiation therapy (RT), or CT plus RT were compared. Kaplan-Meier curves of OS for individual therapy were constructed and compared using the log-rank test. Multivariate analysis for predictors of mortality was conducted using the Cox proportional hazard method. Results: A total of 3795 patients were included in the analysis. At baseline, 41% patients had stage I disease. Of the 3795 patients, 51% underwent CT, 16% underwent RT, and 33% underwent CT plus RT. With a median follow-up duration of 40.4 months, the unadjusted OS rates for patients receiving CT, RT, or CT plus RT were 58.1%, 54%, and 77.7%, respectively (P < .0001). On multivariate analysis, CT plus RT improved OS compared with monotherapy. Conclusion: In older patients (age ≥ 60 years) with stage I/II HL, the combination of CT plus consolidative RT resulted in improved OS compared with monotherapy. However, the use of combination therapy in this age group seems suboptimal. This could be, in part, secondary to comorbidities limiting the use of CT plus RT in the elderly.

UR - http://www.scopus.com/inward/record.url?scp=85030644899&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030644899&partnerID=8YFLogxK

U2 - 10.1016/j.clml.2017.09.009

DO - 10.1016/j.clml.2017.09.009

M3 - Article

JO - Clinical Lymphoma, Myeloma and Leukemia

JF - Clinical Lymphoma, Myeloma and Leukemia

SN - 2152-2669

ER -