Hodgkin's disease, lymphocytic predominance nodular. Increased risk for subsequent non-Hodgkin's lymphomas

Abstract

Fifty‐one cases of Hodgkin's disease, of lymphocytic predominance type, nodular subtype (HDLPN) were singled out from three sources: lymph nodes originally diagnosed as malignant lymphoma, nodes suspected of lymphoma and nodes suspected of toxoplasmosis. Two thirds of the 51 patients were men, and the median age was 42 years. The disease was characteristically unilocular and cervical and axillary nodes were most often involved. Local recurrences were common (in 13 cases). Oncological treatment (irradiation, cytostatics, or both) was given to 20 patients, whereas 31 patients remained untreated as the original histological diagnosis was not malignant. Despite the lack of treatment, the prognosis was good. Relative actuarial survival for the whole material was 93% at five years and 80% at ten years. During follow‐up, five patients developed a diffuse large–celled non‐Hodgkin's lymphoma 4–11 years after the onset of HDLPN. The majority of the subsequent lymphomas cannot be therapy‐induced as only one of these patients had previously been treated (irradiated). Transition to other types of Hodgkin's disease was observed only in two cases. It is concluded that HDLPN is a clinicopathological entity with a good prognosis, but that it may sometimes change into a more malignant lymphoma of the Hodgkin's or non‐Hodgkin's type.

Rituximab in relapsed lymphocyte-predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG)

“…TCRBCL is a variant of diffuse large cell lymphoma with specific characteristic morphologic features, and transformation seems to occur in some NLPHL patients. 5,14 The lymphoma cells resemble the lymphocytic and histiocytic (L&H) cells of NLPHL and share an abundance of reactive cells. These histologic similarities suggest a possible relationship between the 2 entities.…”

“…1,2 NLPHL can resemble T-cell rich B-cell lymphoma (TCRBCL) 3 and often presents in early stages with an indolent course and excellent prognosis. 4,5 Early-stage NLPHL patients treated with chemotherapy are more likely to die from secondary malignancies and cardiovascular disease compared with primary neoplasm. 1 The slow disease progression and the CD20 ϩ tumor cells in NLPHL prompted us to evaluate rituximab in a phase 2 clinical trial.…”

Nodular lymphocyte-predominant Hodgkin lymphoma with nodules resembling T-cell/histiocyte-rich B-cell lymphoma: differential diagnosis between nodular lymphocyte-predominant Hodgkin lymphoma and T-cell/histiocyte-rich B-cell lymphoma

“…Conceptually, these patterns may represent different pathways of progression toward DLBCL, which develops in up to 5% of patients with NLPHL. 33,34 Interestingly, one half of the DLBCLs occurring in the course of NLPHL are of the T/HRBCL variant. 13 This further supports that at least a part of the T/HRBCL may derive from NLPHL and have a follicular origin.…”

Treatment of relapsed CD20+ Hodgkin lymphoma with the monoclonal antibody rituximab is effective and well tolerated: results of a phase 2 trial of the German Hodgkin Lymphoma Study Group

“…In the present trial, 2 cases were diagnosed as CD20 ϩ transformed T-cell-rich B-cell lymphoma upon reference pathology. Several reports describe a higher probability of transformation of LPHD into secondary NHL, [3][4][5] even for those patients who had not received cytotoxic treatment. A clonal relationship between transformed large-cell lymphoma and LPHD was established.…”

“…1,2 In addition, transformation to aggressive non-Hodgkin lymphoma (NHL), including T-cell-rich B-cell lymphoma, has been reported. [3][4][5] Therefore, new therapeutic alternatives for patients with LPHD and patients with relapsed or refractory classical HD are warranted. One possibly very tempting selective new approach would be the use of a specific monoclonal antibody (MoAb) directed against surface antigens present on malignant Hodgkin Reed-Sternberg cells (H-RS).…”