Current Treatment Options and the Role of Functional Status Assessment in Classical Hodgkin Lymphoma in Older Adults: A Review

Simple Summary Hodgkin lymphoma (cHL) in older adults is typically characterized by a prognosis that is markedly worse than that of young patients, due to both greater difficulty in achieving adequate disease control and higher treatment-related toxicity. Although rarely included in clinical trials, older cHL patients represent an unmet clinical challenge, with disease incidence expected to increase in Western countries due to the aging of the general population. This review covers the current clinical and therapeutic landscape of cHL in older patients and describes the useful tools for these patients' care. Particular attention is given to the currently available first-line regimens and the need for a baseline assessment of patient fitness as a criterion for better treatment selection. Along with the fact that classical Hodgkin lymphoma (cHL) in older adults is frequently considered biologically different from cHL in younger patients, its most distinctive feature is its dismal clinical outcome due to the decreased effectiveness and greater toxicity of therapies. Although strategies to mitigate specific toxicities (e.g., cardiological and pulmonary) have obtained some results, in general, reduced-intensity schemes, proposed as an alternative to ABVD, have proved to be less effective. The addition of brentuximab vedotin (BV) to AVD, especially in a sequential scheme, has demonstrated good efficacy. However, the problem of toxicity persists even with this new therapeutic combination, with comorbidities remaining an important prognostic factor. The adequate stratification of functional status is necessary to distinguish between those patients who will benefit from full treatment and those who will benefit from alternative strategies. A simplified geriatric assessment based on the determination of ADL (activity of daily living), IADL (instrumental ADL), and CIRS-G (Cumulative Illness Rating Scale-Geriatric) scores is an easy-to-use tool that permits adequate patient stratification. Other factors of considerable impact on functional status such as sarcopenia and immunosenescence are currently being studied. A fitness-based treatment choice would also be very useful for relapsed or refractory patients, a more frequent and challenging situation than that is found in young cHL patients.