The impact of radiotherapy and attenuated chemotherapy regimens in older patients with classic hodgkin lymphoma. A real-life study from the ReLLi Network

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.