Introduction: Elderly patients (>60 years old) with Hodgkin lymphoma have inferior rates of survival compared to patients <60 years old due to multiple factors including treatment toxicity and comorbidities influencing the intensity of chemotherapy that can be successfully delivered. Hodgkin lymphoma is derived from germinal centre B-cells and contributed to by latent Epstein Barr Virus (EBV) infection in a number of patients.
Aims: To examine the incidence and treatment outcomes of B-cell NHL following completion of treatment for CHL in elderly patients compared with younger patients.
Methods: Adult patients diagnosed with CHL at our institutions from 2000-2015 were followed prospectively following initial treatment for survival and toxicity outcomes. Any subsequent diagnosis of B-cell NHL was confirmed by two expert lymphoma anatomical pathologists consistent with WHO 2008 diagnostic criteria.
Results: 165 adult patients were available for analysis, of which 56 (34%) patients were >60 years old. There was no significant difference between elderly and young cohorts in the number of patients with early stage favourable, unfavourable or advanced stage CHL. Less elderly patients received ABVD-like chemotherapy (71% vs. 95%). There was a higher number of relapses of CHL in elderly patients (31% vs. 20%).
At a median follow-up of surviving patients at 2.7 years, there was a much higher incidence of secondary malignancy in elderly patients n=11 vs. n=2 (24% vs. 2%), of which there were far more haematological compared to solid malignancies n=8 (17%) vs. n=3 (6%). Specific histologies included Diffuse Large B-cell Lymphoma (5), Follicular lymphoma (1), Lymphoplasmacytic lymphoma (1) and Chronic lymphocytic leukaemia (1). Patients with DLBCL were treated with R-CEOP and resulted in 2 patients achieving long-term relapse free survival.
Conclusions: There is a high incidence of B-cell NHL in elderly patients with CHL, suggestive of a common germinal centre derived progenitor cell of origin. Comparative genomic annotation of such cases is required to better understand the lymphoma initiating events in this cohort to enable selection of treatment which may reduce this complication.