Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Lena Specht, University of Copenhagen
- Second opponent: Associate Professor Graham Collins, University of Oxford
- Third member and chair of the evaluation committee: Associate Professor Tor Henrik Anderson Tvedt, University of Oslo
Chair of the Defence
Professor Klaus Beiske, University of Oslo
Principal Supervisor
Alexander Fosså, Oslo University Hospital
Summary
Despite major improvement in treatment of young Hodgkin lymphoma (HL) patients, the prognosis in older individuals remains poor. The overall aim of this thesis was to improve the understanding of the older HL population and to identify bottlenecks that may inform future strategies.
The main research questions addressed demographic and clinical characteristics of a complete selection of older HL patients, treatment outcomes with commonly used chemotherapy regimens, the prognostic impact of frailty-related host factors, and long-term health outcomes among survivors. A central hypothesis was that age-related factors and comorbidity significantly influence prognosis and treatment tolerance beyond established disease-related risk factors.
The thesis is based on population-based data from the Cancer Registry of Norway 2000-2021, supplemented by hospital records, and includes collaborative Scandinavian patient cohorts and matched controls from the general population. With retro- and cross-sectional designs, methods comprised competing risk models and multivariable survival analyses.
Key findings show that older HL patients represent a heterogeneous population with inferior outcomes seen particularly among those treated with palliative intent or deemed ineligible for standard therapy. Treatment with doxorubicin, vinblastine and dacarbazine (AVD) was associated with superior progression-free and overall survival compared to other common options in curatively treated patients. A validated frailty score based on age, comorbidity burden, and performance status demonstrated prognostic value and may guide treatment decisions. Compared to a matched population, long-term survivors generally reported acceptable outcomes, although modest increases in cardiovascular morbidity and reduced functional independence were observed.
Overall, these results provide clinically relevant tools and evidence to optimize future management of older patients with HL.
Additional information
Contact the research support staff.