Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review
Elderly patients make up a significant number of cases of newly diagnosed Hodgkin lymphoma. However, unlike in young patients, the outcomes of elderly patients are poor, and they are under-represented in phase III trials. Prior to treatment initiation, geriatric assessment should ideally be performe...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/10/11/2917 |
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| author | Vibor Milunović Ida Hude Goran Rinčić Davor Galušić Aron Grubešić Marko Martinović Nika Popović Sunčana Divošević Klara Brčić Marin Međugorac Luka Kužat Dejan Strahija Stefan Mrđenović Inga Mandac Smoljanović Delfa Radić-Krišto Slavko Gašparov Igor Aurer Slobodanka Ostojić Kolonić |
| author_facet | Vibor Milunović Ida Hude Goran Rinčić Davor Galušić Aron Grubešić Marko Martinović Nika Popović Sunčana Divošević Klara Brčić Marin Međugorac Luka Kužat Dejan Strahija Stefan Mrđenović Inga Mandac Smoljanović Delfa Radić-Krišto Slavko Gašparov Igor Aurer Slobodanka Ostojić Kolonić |
| author_sort | Vibor Milunović |
| collection | DOAJ |
| description | Elderly patients make up a significant number of cases of newly diagnosed Hodgkin lymphoma. However, unlike in young patients, the outcomes of elderly patients are poor, and they are under-represented in phase III trials. Prior to treatment initiation, geriatric assessment should ideally be performed to address the patient’s fitness and decide whether to pursue a curative or palliative approach. The ABVD regimen is poorly tolerated in unfit patients, with high treatment-related mortality. Alternative chemotherapy approaches have been explored, with mixed results obtained concerning their feasibility and toxicity in phase II trials. The introduction of brentuximab vedotin-based regimens led to a paradigm shift in first- and further-line treatment of elderly Hodgkin lymphoma patients, providing adequate disease control within a broader patient population. As far as checkpoint inhibitors are concerned, we are only just beginning to understand the role in the treatment of this population. In relapsed/refractory settings there are few options, ranging from autologous stem cell transplantation in selected patients to pembrolizumab, but unfortunately, palliative care is the most common modality. Importantly, published studies are frequently burdened with numerous biases (such as low numbers of patients, selection bias and lack of geriatric assessment), leading to low level of evidence. Furthermore, there are few ongoing studies on this topic. Thus, elderly Hodgkin lymphoma patients are hard to treat and represent an unmet need in hematologic oncology. In conclusion, treatment needs to be personalized and tailored on a case-by-case basis. In this article, we outline treatment options for elderly Hodgkin lymphoma patients. |
| first_indexed | 2024-03-09T18:27:26Z |
| format | Article |
| id | doaj.art-74e8d76b553144d3adb32d6f43e07fdb |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-09T18:27:26Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-74e8d76b553144d3adb32d6f43e07fdb2023-11-24T07:46:10ZengMDPI AGBiomedicines2227-90592022-11-011011291710.3390/biomedicines10112917Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A ReviewVibor Milunović0Ida Hude1Goran Rinčić2Davor Galušić3Aron Grubešić4Marko Martinović5Nika Popović6Sunčana Divošević7Klara Brčić8Marin Međugorac9Luka Kužat10Dejan Strahija11Stefan Mrđenović12Inga Mandac Smoljanović13Delfa Radić-Krišto14Slavko Gašparov15Igor Aurer16Slobodanka Ostojić Kolonić17Division of Hematology, Clinical Hospital Merkur, 10000 Zagreb, CroatiaDivision of Hematology, Clinical Hospital Centre Zagreb, 10000 Zagreb, CroatiaDivision of Hematology, Clinical Hospital Centre Sestre Milosrdnice, 10000 Zagreb, CroatiaDivision of Hematology, Clinical Hospital Center Split, 21000 Split, CroatiaDivision of Hematology, Clinical Hospital Center Rijeka, 51000 Rijeka, CroatiaDivision of Hematology, Clinical Hospital Merkur, 10000 Zagreb, CroatiaDivision of Hematology and Oncology, General Hospital, 42000 Varaždin, CroatiaPoliclinic Medikol, 10000 Zagreb, CroatiaDivision of Hematology, Clinical Hospital Centre Sestre Milosrdnice, 10000 Zagreb, CroatiaDivision of Hematology, Clinical Hospital Sveti Duh, 10000 Zagreb, CroatiaDivision of Oncology and Hematology, General Hospital Čakovec, 40000 Čakovec, CroatiaDivision of Hematology and Oncology, General Hospital, 42000 Varaždin, CroatiaDivision of Hematology, Clinical Hospital Center, 31000 Osijek, CroatiaDivision of Hematology, Clinical Hospital Merkur, 10000 Zagreb, CroatiaDivision of Hematology, Clinical Hospital Merkur, 10000 Zagreb, CroatiaDivision of Oncology and Hematology, General Hospital Čakovec, 40000 Čakovec, CroatiaDivision of Hematology, Clinical Hospital Centre Zagreb, 10000 Zagreb, CroatiaDivision of Hematology, Clinical Hospital Merkur, 10000 Zagreb, CroatiaElderly patients make up a significant number of cases of newly diagnosed Hodgkin lymphoma. However, unlike in young patients, the outcomes of elderly patients are poor, and they are under-represented in phase III trials. Prior to treatment initiation, geriatric assessment should ideally be performed to address the patient’s fitness and decide whether to pursue a curative or palliative approach. The ABVD regimen is poorly tolerated in unfit patients, with high treatment-related mortality. Alternative chemotherapy approaches have been explored, with mixed results obtained concerning their feasibility and toxicity in phase II trials. The introduction of brentuximab vedotin-based regimens led to a paradigm shift in first- and further-line treatment of elderly Hodgkin lymphoma patients, providing adequate disease control within a broader patient population. As far as checkpoint inhibitors are concerned, we are only just beginning to understand the role in the treatment of this population. In relapsed/refractory settings there are few options, ranging from autologous stem cell transplantation in selected patients to pembrolizumab, but unfortunately, palliative care is the most common modality. Importantly, published studies are frequently burdened with numerous biases (such as low numbers of patients, selection bias and lack of geriatric assessment), leading to low level of evidence. Furthermore, there are few ongoing studies on this topic. Thus, elderly Hodgkin lymphoma patients are hard to treat and represent an unmet need in hematologic oncology. In conclusion, treatment needs to be personalized and tailored on a case-by-case basis. In this article, we outline treatment options for elderly Hodgkin lymphoma patients.https://www.mdpi.com/2227-9059/10/11/2917Hodgkin lymphomafrail elderlygeriatric assessmentABVD protocolbrentuximab vedotinimmune checkpoint inhibitors |
| spellingShingle | Vibor Milunović Ida Hude Goran Rinčić Davor Galušić Aron Grubešić Marko Martinović Nika Popović Sunčana Divošević Klara Brčić Marin Međugorac Luka Kužat Dejan Strahija Stefan Mrđenović Inga Mandac Smoljanović Delfa Radić-Krišto Slavko Gašparov Igor Aurer Slobodanka Ostojić Kolonić Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review Biomedicines Hodgkin lymphoma frail elderly geriatric assessment ABVD protocol brentuximab vedotin immune checkpoint inhibitors |
| title | Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review |
| title_full | Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review |
| title_fullStr | Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review |
| title_full_unstemmed | Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review |
| title_short | Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review |
| title_sort | clinical dilemmas in the treatment of elderly patients suffering from hodgkin lymphoma a review |
| topic | Hodgkin lymphoma frail elderly geriatric assessment ABVD protocol brentuximab vedotin immune checkpoint inhibitors |
| url | https://www.mdpi.com/2227-9059/10/11/2917 |
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