Treatment of Elderly Hodgkin's Lymphoma Patients. The Experience of the Italian Lymphoma Intergroup

Authors agree in considering advanced age as an unfavorable prognostic factor for Hodgkin's lymphoma'<. However the definition of the best treatment strategy for elderly Hodgkin's lymphoma patients is difficult, mainly because the disease is infrequent in advanced age" and there are so far only few information from prospective trials?". The unfavorable outcome in the elderly is mainly explained by three groups of factors: a) a more advanced stage and/or a peculiar disease biology with a more aggressive behavior; b) the advanced age itself and other age related variables, such as comorbidity; c) the low compliance and the high percentage of toxic events with conventional therapies'". As a consequence of the last point, in the elderly, the efficacy of the best treatment is unbalanced by toxicity and the planned therapy is difficult to follow. The main question is if a conventional treatment like ABVD, or a less toxic strategy devised for elderly people is better. In order to focus this problem, in 1995, the Italian Lymphoma Intergroup started a prospective pilot study with a low aggressive chemotherapy regimen devised for Hodgkin's lymphoma elderly patients.