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Bleomycin for Older Hodgkin Lymphoma Patients: Proceed with Caution
Greater treatment-related toxicity leads to poorer outcomes and lower survival in older adults with Hodgkin lymphoma (HL). The German Hodgkin Lymphoma Study Group has now performed a retrospective analysis of two prior randomized prospective trials (HD10; N Engl J Med 2010; 363:640; and HD13; Lancet 2015; 385:1418) to compare the toxicity of HL treatment regimens in 287 previously untreated patients ≥60 years old (median age, 65) with classical HL. Patients received 2 or 4 cycles of ABVD (doxorubicin, bleomycin, vinblastine sulfate, and dacarbazine) or 2 cycles of AVD (doxorubicin, vinblastine sulfate, and dacarbazine).
Premature treatment discontinuation occurred in 2 of 82 patients (2%) who received 2 cycles of AVD, 5 of 137 (4%) who received 2 cycles of ABVD, and 12 of 68 (18%) who received 4 cycles of ABVD. Bleomycin lung toxicity was observed in 2 patients (1%) who received 2 cycles of ABVD and in 7 (10%) who received 4 cycles of ABVD, including 3 who died.
Comment
Consistent with earlier reports, older patients with classical HL face an increased risk for treatment-related morbidity and mortality compared with younger patients. In particular, bleomycin lung toxicity increases with older age, decreased renal function, history of lung disease or smoking, and use of cytokine therapy. The authors and an editorialist suggest avoiding bleomycin in the presence of these risk factors, both in those with limited-stage disease, as in these trials, as well as in those with more advanced disease; its use should be limited to no more than 2 cycles in patients ≥60 without these risks. Pretreatment pulmonary function studies should be considered in decisions to minimize bleomycin risk.
Citation(s)
Author:
Böll B et al.
Title:
Bleomycin in older early-stage favorable Hodgkin lymphoma patients: Analysis of the German Hodgkin Study Group (GHSG) HD10 and HD13 trials.
Source:
Blood
2016
May
5; [e-pub].
(Abstract/FREE Full Text)
Author:
Moskowitz AJ.
Title:
Bleomycin for older patients: Less is more.
Source:
Blood
2016
May
5; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Michael E. Williams, MD, ScM