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

Abstract

Nodular lymphocyte predominant Hodgkin lymphoma represents a distinct entity from classical Hodgkin lymphoma. We conducted a retrospective study to investigate the management of patients with nodular lymphocyte predominant Hodgkin lymphoma. Clinical characteristics, treatment and outcome of adult patients with nodular lymphocyte predominant Hodgkin lymphoma were collected in Lymphoma Study Association centers. Progression-free survival (PFS) and overall survival (OS) were analyzed, and the competing risks formulation of a Cox regression model was used to control the effect of risk factors on relapse or death as competing events. Among 314 evaluable patients, 82.5% had early stage nodular lymphocyte predominant Hodgkin lymphoma. Initial management consisted in watchful waiting (36.3%), radiotherapy (20.1%), rituximab (8.9%), chemotherapy or immuno-chemotherapy (21.7%), combined modality treatment (12.7%), or radiotherapy plus rituximab (0.3%). With a median follow-up of 55.8 months, the 10-year PFS and OS estimates were 44.2% and 94.9%, respectively. The 4-year PFS estimates were 79.6% after radiotherapy, 77.0% after rituximab alone, 78.8% after chemotherapy or immuno-chemotherapy, and 93.9% after combined modality treatment. For the whole population, early treatment with chemotherapy or radiotherapy, but not rituximab alone (Hazard ratio 0.695 [0.320-1.512], P=0.3593) significantly reduced the risk of progression compared to watchful waiting ], P=0.0002).Early treatment appears more beneficial compared to watchful waiting in terms of progression-free survival, but has no impact on overall survival. Radiotherapy in selected early stage nodular lymphocyte predominant Hodgkin lymphoma, and combined modality treatment, chemotherapy or immuno-chemotherapy for other patients, are the main options to treat adult patients with a curative intent. Nodular lymphocyte predominant Hodgkin lymphoma: a Lymphoma Study Association retrospective study

Nodular lymphocyte predominant Hodgkin's lymphoma in daily practice: A multicenter experience

“…There were a low frequency of patients with early stage disease who were treated with radiotherapy alone. This might be related with some previous reports indicating a high frequency of early and late relapses in early stage patients who were initially treated with limited site radiotherapy . Immunotherapy was mainly reserved to later treatment lines.…”

“…and extranodal involvements despite relatively high proportion of advanced stage disease.None of the patients was followed with a watchful waiting approach at our study. In a recent study of Lazarovici et al, early treatment appeared more beneficial compared to watchful waiting in terms of PFS but has no impact on overall survival 17. It is still a debate whether early stage NLPHL patients should be carefully watched without therapy or not.…”

Nodular lymphocyte predominant Hodgkin lymphoma: pathology, clinical course and relation to T-cell/histiocyte rich large B-cell lymphoma

“…Individuals with stage I/II disease accounted for 82.5% of patients, whereas only 17.5% of patients had stage III/IV disease. 12 The median age at diagnosis (37 years and 38 years) and the proportion of male patients (75% and 77.7%) in the GHSG and LYSA studies were also comparable. 11,12 An association between a variant histology (growth pattern C-F according to Fan et al) 9 and more advanced disease at the initial NLPHL diagnosis has been demonstrated in several studies.…”

“…12 The median age at diagnosis (37 years and 38 years) and the proportion of male patients (75% and 77.7%) in the GHSG and LYSA studies were also comparable. 11,12 An association between a variant histology (growth pattern C-F according to Fan et al) 9 and more advanced disease at the initial NLPHL diagnosis has been demonstrated in several studies. 7,13 A retrospective analysis from the GHSG including a total of 413 patients, indicated that 29.5% of patients with a variant histology had advanced stage disease at the time of initial NLPHL diagnosis.…”

Rituximab plus ABVD in newly diagnosed nodular lymphocyte‐predominant Hodgkin lymphoma

“…For the 18 remaining patients with advanced‐stage disease, 6/7 patients in the rituximab arm progressed and 5‐year PFS was only 28·6% compared to 66·7% in the non‐rituximab arm (King et al , ). Another larger retrospective study (314 evaluable cases) showed early treatment with chemotherapy or RT, but not rituximab alone, reduced the risk of progression compared to watchful waiting, even if there was no impact on OS (Lazarovici et al , ). Fanale () conducted an interesting retrospective analysis in which 12 advanced‐stage patients received R‐CHOP, with an ORR of 100%, a CR rate of 90% and no relapses or transformations after a median follow‐up of 42 months.…”