# The Impact of Radiotherapy and Attenuated Chemotherapy Regimens in Older Patients with Classic Hodgkin Lymphoma: A Real-Life Study from the ReLLi Network

## TL;DR

This study examines treatment outcomes for older patients with classic Hodgkin lymphoma, finding that radiotherapy and adjusted chemotherapy improve survival.

## Contribution

The study provides real-life evidence on treatment efficacy in older Hodgkin lymphoma patients, emphasizing radiotherapy's role and adjusted chemotherapy regimens.

## Key findings

- Patients aged 60–69 with curative treatment achieve excellent long-term survival.
- Radiotherapy significantly improves overall survival in older patients.
- Reduced-dose anthracycline regimens are as effective as standard doses in older patients.

## Abstract

Subjects aged ≥60 years with classic Hodgkin lymphoma (eHL) represent a distinct subgroup of Hodgkin lymphoma, differing clinically, biologically, and prognostically. In fact, eHL has historically been associated with poorer outcomes compared to younger patients. This study explores the outcomes of 150 eHL patients enrolled in a multicenter, real-life dataset that includes a total of 751 patients diagnosed between 2013 and 2018. Both traditional statistical analyses and machine learning algorithms were used to generate synthetic data. We highlight that while patients aged 60–69 treated with curative intent achieve excellent long-term outcomes, those aged ≥70 remain an unmet clinical need, experiencing worse outcomes even after achieving complete remission (CR). Another key finding of this study is the positive impact of radiotherapy on the overall survival of older patients, as well as the comparable efficacy of reduced-dose versus standard-dose anthracycline-containing regimens. The introduction of novel antibodies, particularly in sequential regimens, is expected to improve outcomes in eHL.

Background/Objectives: The treatment of older patients with classic Hodgkin lymphoma (eHL) remains a challenge. Methods: This study reports the first real-life survey of eHL treated with contemporary therapies in Italy. One hundred and fifty eHL patients were treated between 2013 and 2018: seventy-one were aged 60–69 years and seventy-nine ≥70 years (median age 70.5 years; range = 60–89). Curative treatments included ABVD-like regimens and attenuated approaches alternating ABVD-like regimens with non-anthracycline-containing cycles. Results: After a median follow-up of 81 months, the 5-year overall survival (OS) was 87% for patients aged 60–69 and 62% for those aged ≥70. Among 132 patients (88%) treated with curative intent, the 5-year cancer-specific survival (CSS) was 93% for the 60–69 group and 70% for the ≥70 group, while event-free survival (EFS) was 78% and 58%, respectively (p < 0.001). Multivariate analysis showed that age ≥ 70, omission of radiotherapy (RT), and failure to achieve complete remission (CR) after chemotherapy were significant predictors of OS, CSS, and EFS. Synthetic data analysis confirmed that omitting RT worsens outcomes at all stages, while reduced-dose anthracycline regimens are non-inferior to full-dose schedules. Conclusions: This survey highlights key prognostic factors and supports the optimization of future treatment strategies including targeted drugs.