Nodular and Diffuse Types of Lymphocyte Predominance Hodgkin's Disease

Abstract

The nodular form of lymphocyte predominance Hodgkin's disease has been shown to be immunophenotypically distinct from the histologically diffuse form and from other types of Hodgkin's disease. We undertook a clinicopathological study of 73 cases to determine whether any clinical differences between the nodular and diffuse subtypes could be discerned. Patients with the diffuse form (n = 41) tended to have a course similar to that of other types of Hodgkin's disease; there were few relapses and only two deaths due to Hodgkin's disease. In contrast, patients with the nodular form (n = 32) had significantly more relapses, which were independent of stage or treatment and equally distributed up to 10 years after initial therapy. Despite the frequent relapses, patients with the nodular form had an indolent course, and there was only one death due to Hodgkin's disease. There were seven fatal second cancers and two non-neoplastic treatment-related deaths, equally distributed between the nodular and diffuse groups. We conclude that nodular lymphocyte predominance Hodgkin's disease may have important clinical as well as immunophenotypic differences from other forms of Hodgkin's disease, and that patients with this condition should be followed carefully because of the possibility of late relapse.

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

“…The histologic subtype of LPHD does not appear to affect overall survival. 4,18 There was a low incidence of second malignancies in this study. The incidence of second malignancies, Š FIGURE 3.…”

“…1). Regula et al 18 obtained similar results (10-year RFS and OS rates: 76% and 82%, respectively) in patients with LPHD, most of whom had Stage I-II disease that was treated with radiotherapy alone. In accordance with these findings, Bodis et al 5 reported 10-year RFS and OS rates of 80% and 93%, respectively, in patients with LPHD.…”

“…21 Although some groups 6,8,18 have observed late recurrences in patients with nodular LPHD, other groups [22][23][24] have not. In the current study, the histologic subtype of LPHD was not specified in 21% of patients; in addition, diffuse architecture was confirmed in only 4% of patients (Table 1).…”

“…Specimens with focal nodularity that accounted for at least 10% of the involved tissue were classified as nodular. 5,18 Diffuse architecture was defined as effacement of nodal architecture with only 1-9% of the architecture showing nodularity by routine histologic or immunologic stain. Patients with specimens that were entirely diffuse were diagnosed with T-cell-rich B-cell lymphoma and were excluded from the study.…”

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

“…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).…”