Hodgkin lymphoma in the elderly: A clinical review of treatment and outcome, past, present and future

Hodgkin lymphoma (HL) is a curable cancer in the vast majority of patients under the age of 60 years. Because of the rarity of the disease in older people, and age related factors such as co-morbidity, inability to tolerate aggressive chemotherapy, poor ECOG status at presentation and issues relating to frailty, the literature is sparse and no prospective randomised studies exist. The incidence of HL in the over 60s range between 10% and 20% of the disease overall and, as a potentially curable cancer, new specific treatment approaches designed for the elderly are necessary. This review discusses the available data in relation to treatments and outcome to date, and proposes how future studies and evaluations might be constructed for this disease. The SHIELD study (Study of Hodgkin lymphoma in the Elderly/Lymphoma Database) is a current example of an approach aimed at objectively defining some of the difficulties of this patient population.