TOPLINE

In patients aged 60 years or older with classical Hodgkin lymphoma (cHL), first-line therapy with doxorubicin, vinblastine, and dacarbazine (AVD) was associated with longer progression-free survival and, in an initial adjusted analysis, overall survival compared to standard doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) in a Nordic population-based study. However, the association with overall survival was attenuated after additional adjustment, and the AVD group was relatively small and differed from the ABVD group in age and other characteristics.

METHODOLOGY

• Older patients with cHL have poorer outcomes because of frailty, comorbidities, and treatment-related toxicity. While ABVD is standard, bleomycin increases the risk for lung toxicity in older patients. AVD’s comparative effectiveness in routine care remains uncertain.
• In a retrospective, population-based cohort study, researchers analyzed data from 1569 patients aged 60 years or older with newly diagnosed cHL between January 2000 and December 2021 to compare overall survival and progression-free survival for different first-line regimens, including ABVD, AVD, cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), and other therapies.
• Patients received ABVD (n = 671; median age, 66 years), AVD (n = 123; median age, 74 years), CHOP (n = 481; median age, 72 years), or other chemotherapy regimens (n = 212; median age, 72 years).
• Patients with limited-stage disease often received AVD plus radiotherapy, while those with advanced-stage disease received two courses of ABVD plus four courses of AVD.

TAKEAWAY

• Compared with ABVD, AVD was associated with significantly improved overall survival in the initial adjusted model (adjusted hazard ratio [aHR], 0.38), but the association was attenuated and no longer statistically significant after additional adjustment for performance status and B symptoms (HR, 0.66; 95% CI, 0.40-1.09).
• AVD was associated with significantly improved progression-free survival compared with ABVD in both models (aHR, 0.45 and 0.47, respectively).
• Compared with ABVD, CHOP was not associated with significantly improved overall survival (aHR, 1.09; 95% CI, 0.89-1.34) or progression-free survival (aHR, 0.91; 95% CI, 0.75-1.09).
• Among patients with limited-stage disease, 5-year overall survival was 97% for AVD, 83% for ABVD, 69% for CHOP, and 57% for other regimens. For patients with advanced-stage disease, 5-year overall survival was 73% for AVD, 61% for ABVD, 49% for CHOP, and 45% for other regimens.

IN PRACTICE

“AVD is at least equal to ABVD and CHOP and superior to other chemotherapy regimens with respect to disease control but with less expected toxicity than ABVD, due to the exclusion of bleomycin,” the authors wrote. 

Editorialists agreed that, despite caveats, “this study provides compelling real-world evidence that AVD achieves at least equivalent efficacy to ABVD, with the expected reduction in treatment-related toxicity among older patients with cHL.”

SOURCE

The study was led by Ninja Overgaard, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. It was published online in Blood Advances.

LIMITATIONS

The study was limited by its retrospective design, incomplete comorbidity data, and the relatively small sample size and short follow-up of the AVD treatment group. Additionally, combined response-adapted strategies, such as de-escalation from ABVD to AVD, were not fully captured in the Danish Lymphoma Registry, limiting assessment of real-world treatment changes.

DISCLOSURES

The study was funded by grants from Cancerfonden, Svenska Sällskapet för Medicinsk Forskning, Stiftelsen Onkologiska Klinikens i Uppsala Cancerforskningsfond, and Lion’s Cancerforskningsfond vid Akademiska sjukhuset. Some authors reported receiving honoraria or research support from or having other ties with various sources including Roche, Merck, Bristol Myers Squibb, Takeda, AbbVie, and others. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.