European Organization for Research and Treatment of Cancer and Groupe d'Etude des Lymphomes de l'Adulte very favorable and favorable, lymphocyte‐predominant Hodgkin disease

Abstract

BACKGROUNDLymphocyte‐predominant Hodgkin disease (LPHD) is rare and has a natural history different from that of classic Hodgkin disease. There is little information in the literature regarding the role of chemotherapy in patients with early‐stage LPHD. The objective of this study was to examine recurrence free survival (RFS), overall survival (OS), and patterns of first recurrence in patients with LPHD who were treated with radiotherapy alone or with chemotherapy followed by radiotherapy.METHODSFrom 1963 to 1996, 48 consecutive patients ages 16–49 years (median, 28 years) with Ann Arbor Stage I (n = 30 patients) or Stage II (n = 18 patients), very favorable (VF; n = 5 patients) or favorable (F; n = 43 patients) LPHD, according to the European Organization for Research and Treatment of Cancer and Groupe d'Etude des Lymphomes de l'Adulte (EORTC‐GELA) criteria, received radiotherapy alone (n = 37 patients) or received chemotherapy followed by radiotherapy (n = 11 patients). The percentages of patients with VF disease (11% vs. 9% in the radiotherapy group vs. the chemotherapy plus radiotherapy group, respectively) or F disease (89% vs. 91%, respectively) within the two treatment groups were similar (P = 1.00). A median of three cycles of chemotherapy with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or with mitoxantrone, vincristine, vinblastine, and prednisone (NOVP) was given initially to six patients and five patients, respectively. A median total radiotherapy dose of 40 grays (Gy) given in daily fractions of 2.0 Gy was delivered to both treatment groups.RESULTSThe median follow‐up was 9.3 years, and 98% of patients were observed for ≥ 3.0 years. RFS was similar for patients who were treated with radiotherapy alone and patients who were treated with chemotherapy followed by radiotherapy (10‐year survival rates: 77% and 68%, respectively; P = 0.89). The OS rate also was similar for the two groups (10‐year survival rates: 90% and 100%, respectively; P = 0.43). MOPP or NOVP chemotherapy did not reduce the risk of recurrence outside of the radiotherapy fields.CONCLUSIONSMOPP or NOVP chemotherapy did not improve RFS or OS significantly in patients with VF or F LPHD, although the statistical power was limited. Ongoing clinical trials will help to clarify the role of a watch‐and‐wait strategy or systemic therapy, including anthracycline (epirubicin or doxorubicin), bleomycin, and vinblastine‐based chemotherapy or antibody‐based approaches, in the treatment of these patients. Cancer 2002;94:1731–8. © 2002 American Cancer Society.DOI 10.1002/cncr.10404

Nodular lymphocyte predominant Hodgkin lymphoma: a Lymphoma Study Association retrospective study

“…6 The risk of progression was reduced with radiotherapy compared to watchful waiting. However, with a 4-year PFS estimate of 79.6% for patients treated with radiotherapy alone, the benefit of radiotherapy is inferior to the results of previously published studies, 8,13,14 and relapses occurred in most cases outside the irradiated fields. Due to the low number of patients and events, a comparison between the results of radiotherapy in stage I and stage II was not possible.…”

Treating limited-stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome

“…The M. D. Anderson Cancer Center compared the survival of 48 patients with limited-stage NLPHL by treatment received (CMT alone n ϭ 11 vs radiotherapy alone n ϭ 37) and found no difference in outcome (10-year relapse-free survival 77% vs 68%, P ϭ .89); however, patient numbers were small and the chemotherapy used may be inferior to ABVD (MOPP or NOVP (mitoxantrone, vincristine, vinblastine, and prednisone). 16 Feugier et al reported a 10-year FFP (failure from progression) of 80% using combined modality therapy in 42 patients with stage IA (n ϭ 24) or 2A (n ϭ 18) disease, but treatment was variable in some cases using only 1 cycle of ABVD or alternate chemotherapy EBVM, which also may not have similar efficacy to ABVD 14 (Table 2). A recently published population-based study with pathologic review evaluated 113 patients, with "early"-stage NLPHL, including 93 patients treated with radiotherapy alone and 20 who had received either CMT (n ϭ 13) or chemotherapy For personal use only.…”

18-F FDG-PET in the staging of lymphocyte-predominant Hodgkin's disease

“…3,4 This disease requires regular follow up due to the tendency toward frequent relapses. 4,5 No consensus has been yet established on the management of LPHD, as chemotherapy, 6 radiotherapy, 7 immunotherapy, 8 and watch and wait attitude are possible options. 9 Positron emission tomography using 2-[18F]fluoro-2-deoxy-D-glucose (FDG-PET) plays an important role in evaluation of HL and non Hodgkin's lymphoma (NHL), for staging and therapy assessment.…”