Prognostic impact of treatment-related and geriatric factors in older patients with classic Hodgkin lymphoma: A real-life cohort study

Older patients with classic Hodgkin lymphoma experience poorer outcomes than younger individuals, due to comorbidities and functional limitations affecting treatment tolerance. In this retrospective single-centre study of 140 patients, we evaluated treatment patterns, outcomes and the prognostic value of two geriatric scores: the Age, Comorbidities and Albumin (ACA) Index and the Frailty Score. Most patients (87.9%) received standard ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine)/AVD (doxorubicin, vinblastine and dacarbazine) regimens. At median follow-up (65 months), 5-year progression-free survival (PFS) and overall survival (OS) were 65% and 78.5%, respectively; treatment-related mortality was 7.8%. First-line therapy (AVD-based versus other) significantly influenced PFS (61.8% vs. 23.5%, p = 0.002) and OS (69.1% vs. 35.3%, p = 0.001). ACA Index stratified patients into four risk categories with progressively lower 5-year OS (92%–64.3%, p = 0.003). According to Frailty Score, 37.9% were fit, 54.3% unfit and 7.8% frail, with corresponding 5-year OS of 79.2%, 59.2% and 36.4% (p < 0.0001). Multivariate analysis identified age ≥80 years, extra-nodal involvement and advanced stage according to German Hodgkin Study Group (GHSG) classification as independent predictors of PFS; age ≥80 years, advanced stage (GHSG) and Frailty Score independently predicted OS. Our findings confirm that standard therapies achieve favourable outcomes in older patients, but chronological age alone is insufficient for treatment decisions. The Frailty Score offers an accessible prognostic tool to guide therapy, supporting the integration of geriatric assessment into treatment planning for this underrepresented population.