Treatment of older patients with Hodgkin lymphoma

Abstract

Older patients with classic Hodgkin lymphoma (HL) often experience poor outcomes due to age-related comorbidities and treatment-related toxicity. Comprehensive geriatric assessment and supportive care measures, including pre-phase corticosteroids, growth factor prophylaxis, and organ function monitoring, are essential for optimizing treatment tolerance in this vulnerable patient population. Recent phase III trial (S1826) demonstrated that nivolumab plus doxorubicin, vinblastine, and dacarbazine (Nivo + AVD) significantly improves progression-free survival and is better tolerated than brentuximab vedotin (BV) + AVD, particularly in patients over 60 years of age. Given its efficacy and reduced toxicity, Nivo + AVD is likely to become a key treatment option for fit older patients with HL. For frail patients, chemo-free approaches with BV and checkpoint inhibitors remain viable alternatives. Future research should refine fitness-based treatment strategies, integrate novel agents, and enhance supportive care to improve outcomes and minimize treatment-related toxicity in this population.