AVD is an effective chemotherapy backbone in first-line treatment of older patients with classical Hodgkin lymphoma.

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Abstract
No universal gold standard chemotherapy exists for the treatment of older (≥60 years) patients with classical Hodgkin lymphoma (cHL). To evaluate the current curative treatment strategies used in the Nordic countries, we collected data from patients diagnosed in Sweden, Denmark and Norway during the years 2000 to 2021. We included 1569 patients: 704 (45%) Swedish, 671 (43%) Danish and 194 (12%) Norwegian. Of these, 671 (43%) received doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD), 123 (8%) received doxorubicin, vinblastine, dacarbazine (AVD), 465 (31%) received cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) and 212 (13%) received other chemotherapy (single agent or combination). Eighty-two patients (5%) lacked information on first line regimen. In multivariable analyses of overall survival (OS), treatment with AVD was associated with improved survival compared to ABVD, whereas there was a trend toward inferior survival among patients receiving CHOP or other regimens. For progression-free survival (PFS), multivariable analysis likewise demonstrated significantly improved outcome with AVD relative to ABVD, while outcomes for the CHOP group were comparable to ABVD. Outcome for patients receiving other regimens tended to be poorer. Collectively, outcome for AVD with respect to both OS and PFS was at least equal to ABVD and often superior to CHOP. By omitting bleomycin, treatment-related toxicity is known to be reduced in AVD compared to ABVD. Based on our findings, AVD is a preferable chemotherapy option in older cHL patients and should rightly be considered as backbone in treatment with novel drugs.

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