Outcome of Elderly Patients with Hodgkin's Disease-Single Centre Experience from Riyadh, Saudi Arabia

Background: Hodgkin's disease accounts for approximately 10% of all lymphoma cases. There is a bimodal distribution with initial peak in second decade and a later peak in sixth decade. There is paucity of date on outcome of elderly patients with Hodgkin's disease. There is hardly any data from middle eastern patients.

Materials and Methods: We retrospectively analyzed 168 consecutive patients diagnosed with Hodgkin's disease at our centre from 2006 to 2015 (age>14 years) and found 16 patients to be over the age of 60 years.

Results: Out of 16 patients 6 were females, 10 were males and the median age was 70 years (range 61-86).All patients had classical Hodgkin's disease out of which 12 had nodular sclerosis subtype, 2 had mixed cellularity subtype and 1 had lymphocyte rich subtype. 4 patients had early stage disease (IA-IIA) while rest 12 had advanced stage disease. 15 were treated with ABVD based regimen, the other was treated with chlorambucil based regimen.3 out of 16 were given radiation in addition to chemotherapy. Out of the 14 evaluable patients (two were lost to follow up) 13 completed treatment and all of them achieved complete remission (93%).9 of 16 patients were given reduced dose doxorubicin. Three patients died (one due to sepsis, the other due cardiomyopathy 2 years after treatment, third one due secondary cancer).None of the alive patients have relapsed yet. One patient developed secondary cancer who later died with the same. At a median follow up of 35 months (range 1-72) even free survival and overall survival were 79% and 86% respectively.

Discussion: As per our study unlike in western world, older patients are less frequently affected with Hodgkin's disease. The remission rates and survival data are very encouraging despite dose reductions, however further data from this part of the world is needed to confirm our results. ABVD appears feasible, effective treatment option for elderly patients although frail patients who cannot tolerate ABVD may be candidates for anti CD30 antibody based regimens.