Probability of cure in elderly Hodgkin's disease patients.

A. Levis, L. Depaoli, A. Urgesi, M. Bertini, L. Orsucci, U. Vitolo, G. Buchi, A. Gallamini, P. Gavarotti, A. Novarino, D. R. Scalabrini, U. Mazza, A. Pileri, G. L. Sannazzari, L. Resegotti

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Abstract

BACKGROUND: Elderly Hodgkin's disease patients have a poor prognosis. The question arises whether these patients need aggressive treatment or a palliative strategy. So far, as a consequence of the scarcity of trials designed for them, useful information can be obtained only by retrospective analyses. METHODS: We retrospectively studied clinical data from 567 patients recorded from 1982 to 1989 in the Piemonte Hodgkin's Disease Register (PHDR). The 65 patients over 65 years of age were compared to younger ones. We analyzed the role of disease independently of confounding variables, mainly inadequacy of staging and/or treatment, comorbidity and toxicity. RESULTS: In the elderly comorbidity was as high as 35%. Forty elderly patients (60%) entered a suboptimal plan with a low degree of aggressivity, which was different from the usual PHDR protocol. Elderly patients also had a high proportion of subsequent protocol interruptions (25%). Chemotherapy dose intensity was negatively affected by advanced age (p <0.01 after both 3 and 6 courses of chemotherapy). Toxic deaths were significantly higher in elderly patients than in younger ones (14% vs 1%; p <0.05). CR rates, overall survival (OS), disease-specific survival (DSS) and event free survival (EFS) were all significantly influenced by age (p <0.01). Relapse-free survival (RFS) in patients achieving CR did not differ according to age class (77% vs 60%; p = ns). RFS was better in elderly patients entering the PHDR protocols than in those following an alternative plan (75% vs 54%; p = 0.04); however, elderly patients treated according to PHDR guidelines showed a higher incidence of toxic deaths than those treated less aggressively (23% vs 8%). The two groups had similar EFS (36% vs 24%; p = ns). CONCLUSIONS: Elderly patients who achieve CR can have good RFS and cure is possible, but the toxic cost of conventional strategies is unacceptable and selected strategies still must be found.

Original languageEnglish
Pages (from-to)46-54
Number of pages9
JournalHaematologica
Volume79
Issue number1
Publication statusPublished - Jan 1994

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Hodgkin Disease
Poisons
Survival
Recurrence
Disease-Free Survival
Comorbidity
Drug Therapy
Confounding Factors (Epidemiology)
Survival Rate
Guidelines
Costs and Cost Analysis
Incidence

ASJC Scopus subject areas

  • Hematology

Cite this

Levis, A., Depaoli, L., Urgesi, A., Bertini, M., Orsucci, L., Vitolo, U., ... Resegotti, L. (1994). Probability of cure in elderly Hodgkin's disease patients. Haematologica, 79(1), 46-54.

Probability of cure in elderly Hodgkin's disease patients. / Levis, A.; Depaoli, L.; Urgesi, A.; Bertini, M.; Orsucci, L.; Vitolo, U.; Buchi, G.; Gallamini, A.; Gavarotti, P.; Novarino, A.; Scalabrini, D. R.; Mazza, U.; Pileri, A.; Sannazzari, G. L.; Resegotti, L.

In: Haematologica, Vol. 79, No. 1, 01.1994, p. 46-54.

Research output: Contribution to journalArticle

Levis, A, Depaoli, L, Urgesi, A, Bertini, M, Orsucci, L, Vitolo, U, Buchi, G, Gallamini, A, Gavarotti, P, Novarino, A, Scalabrini, DR, Mazza, U, Pileri, A, Sannazzari, GL & Resegotti, L 1994, 'Probability of cure in elderly Hodgkin's disease patients.', Haematologica, vol. 79, no. 1, pp. 46-54.
Levis A, Depaoli L, Urgesi A, Bertini M, Orsucci L, Vitolo U et al. Probability of cure in elderly Hodgkin's disease patients. Haematologica. 1994 Jan;79(1):46-54.
Levis, A. ; Depaoli, L. ; Urgesi, A. ; Bertini, M. ; Orsucci, L. ; Vitolo, U. ; Buchi, G. ; Gallamini, A. ; Gavarotti, P. ; Novarino, A. ; Scalabrini, D. R. ; Mazza, U. ; Pileri, A. ; Sannazzari, G. L. ; Resegotti, L. / Probability of cure in elderly Hodgkin's disease patients. In: Haematologica. 1994 ; Vol. 79, No. 1. pp. 46-54.
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abstract = "BACKGROUND: Elderly Hodgkin's disease patients have a poor prognosis. The question arises whether these patients need aggressive treatment or a palliative strategy. So far, as a consequence of the scarcity of trials designed for them, useful information can be obtained only by retrospective analyses. METHODS: We retrospectively studied clinical data from 567 patients recorded from 1982 to 1989 in the Piemonte Hodgkin's Disease Register (PHDR). The 65 patients over 65 years of age were compared to younger ones. We analyzed the role of disease independently of confounding variables, mainly inadequacy of staging and/or treatment, comorbidity and toxicity. RESULTS: In the elderly comorbidity was as high as 35{\%}. Forty elderly patients (60{\%}) entered a suboptimal plan with a low degree of aggressivity, which was different from the usual PHDR protocol. Elderly patients also had a high proportion of subsequent protocol interruptions (25{\%}). Chemotherapy dose intensity was negatively affected by advanced age (p <0.01 after both 3 and 6 courses of chemotherapy). Toxic deaths were significantly higher in elderly patients than in younger ones (14{\%} vs 1{\%}; p <0.05). CR rates, overall survival (OS), disease-specific survival (DSS) and event free survival (EFS) were all significantly influenced by age (p <0.01). Relapse-free survival (RFS) in patients achieving CR did not differ according to age class (77{\%} vs 60{\%}; p = ns). RFS was better in elderly patients entering the PHDR protocols than in those following an alternative plan (75{\%} vs 54{\%}; p = 0.04); however, elderly patients treated according to PHDR guidelines showed a higher incidence of toxic deaths than those treated less aggressively (23{\%} vs 8{\%}). The two groups had similar EFS (36{\%} vs 24{\%}; p = ns). CONCLUSIONS: Elderly patients who achieve CR can have good RFS and cure is possible, but the toxic cost of conventional strategies is unacceptable and selected strategies still must be found.",
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AU - Depaoli, L.

AU - Urgesi, A.

AU - Bertini, M.

AU - Orsucci, L.

AU - Vitolo, U.

AU - Buchi, G.

AU - Gallamini, A.

AU - Gavarotti, P.

AU - Novarino, A.

AU - Scalabrini, D. R.

AU - Mazza, U.

AU - Pileri, A.

AU - Sannazzari, G. L.

AU - Resegotti, L.

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N2 - BACKGROUND: Elderly Hodgkin's disease patients have a poor prognosis. The question arises whether these patients need aggressive treatment or a palliative strategy. So far, as a consequence of the scarcity of trials designed for them, useful information can be obtained only by retrospective analyses. METHODS: We retrospectively studied clinical data from 567 patients recorded from 1982 to 1989 in the Piemonte Hodgkin's Disease Register (PHDR). The 65 patients over 65 years of age were compared to younger ones. We analyzed the role of disease independently of confounding variables, mainly inadequacy of staging and/or treatment, comorbidity and toxicity. RESULTS: In the elderly comorbidity was as high as 35%. Forty elderly patients (60%) entered a suboptimal plan with a low degree of aggressivity, which was different from the usual PHDR protocol. Elderly patients also had a high proportion of subsequent protocol interruptions (25%). Chemotherapy dose intensity was negatively affected by advanced age (p <0.01 after both 3 and 6 courses of chemotherapy). Toxic deaths were significantly higher in elderly patients than in younger ones (14% vs 1%; p <0.05). CR rates, overall survival (OS), disease-specific survival (DSS) and event free survival (EFS) were all significantly influenced by age (p <0.01). Relapse-free survival (RFS) in patients achieving CR did not differ according to age class (77% vs 60%; p = ns). RFS was better in elderly patients entering the PHDR protocols than in those following an alternative plan (75% vs 54%; p = 0.04); however, elderly patients treated according to PHDR guidelines showed a higher incidence of toxic deaths than those treated less aggressively (23% vs 8%). The two groups had similar EFS (36% vs 24%; p = ns). CONCLUSIONS: Elderly patients who achieve CR can have good RFS and cure is possible, but the toxic cost of conventional strategies is unacceptable and selected strategies still must be found.

AB - BACKGROUND: Elderly Hodgkin's disease patients have a poor prognosis. The question arises whether these patients need aggressive treatment or a palliative strategy. So far, as a consequence of the scarcity of trials designed for them, useful information can be obtained only by retrospective analyses. METHODS: We retrospectively studied clinical data from 567 patients recorded from 1982 to 1989 in the Piemonte Hodgkin's Disease Register (PHDR). The 65 patients over 65 years of age were compared to younger ones. We analyzed the role of disease independently of confounding variables, mainly inadequacy of staging and/or treatment, comorbidity and toxicity. RESULTS: In the elderly comorbidity was as high as 35%. Forty elderly patients (60%) entered a suboptimal plan with a low degree of aggressivity, which was different from the usual PHDR protocol. Elderly patients also had a high proportion of subsequent protocol interruptions (25%). Chemotherapy dose intensity was negatively affected by advanced age (p <0.01 after both 3 and 6 courses of chemotherapy). Toxic deaths were significantly higher in elderly patients than in younger ones (14% vs 1%; p <0.05). CR rates, overall survival (OS), disease-specific survival (DSS) and event free survival (EFS) were all significantly influenced by age (p <0.01). Relapse-free survival (RFS) in patients achieving CR did not differ according to age class (77% vs 60%; p = ns). RFS was better in elderly patients entering the PHDR protocols than in those following an alternative plan (75% vs 54%; p = 0.04); however, elderly patients treated according to PHDR guidelines showed a higher incidence of toxic deaths than those treated less aggressively (23% vs 8%). The two groups had similar EFS (36% vs 24%; p = ns). CONCLUSIONS: Elderly patients who achieve CR can have good RFS and cure is possible, but the toxic cost of conventional strategies is unacceptable and selected strategies still must be found.

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