The time to relapse correlates with the histopathological growth pattern in nodular lymphocyte predominant Hodgkin lymphoma

Abstract

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) can present with different histopathological growth patterns. The impact of these histopathological growth patterns on relapse characteristics is unknown. We therefore analyzed paired biopsies obtained at initial diagnosis and relapse from 33 NLPHL patients who had received first‐line treatment within German Hodgkin Study Group (GHSG) trial protocols, and from a second cohort of 41 relapsed NLPHL patients who had been treated outside GHSG studies. Among the 33 GHSG patients, 21 patients presented with a typical growth pattern at initial diagnosis, whereas 12 patients had a variant histology. The histopathological growth patterns at initial diagnosis and at relapse were consistent in 67% of cases. A variant histology at initial diagnosis was associated with a shorter median time to lymphoma recurrence (2.8 vs 5.2 years; P = .0219). A similar tendency towards a shorter median time to lymphoma recurrence was observed for patients presenting with a variant histology at relapse, irrespective of the growth pattern at initial diagnosis. Results obtained from the 41 NLPHL patients who had been treated outside GHSG studies were comparable (median time to lymphoma recurrence for variant histology vs typical growth pattern at initial diagnosis: 1.5 vs 7.0 years). In conclusion, the histopathological growth pattern remains consistent at relapse in the majority of NLPHL cases, and has major impact on the time of relapse.

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

“…7 In these patients, relapses also occur at an earlier time point than in patients with typical NLPHL. 77 In most patients, the histopathological growth pattern at relapse is consistent with the one observed at initial diagnosis. However, a switch from a typical to a variant growth pattern and vice versa is found in a subset of patients.…”

Pitfalls in the Diagnosis of Nodular Lymphocyte Predominant Hodgkin Lymphoma: Variant Patterns, Borderlines and Mimics

“…The presence of variant patterns was found to be an independent prognostic factor associated with advanced disease and higher relapse rates. In addition, variant histology at the initial diagnosis was found to persist at a recurrence in the majority of patients and variant histology at initial diagnosis as well as at a relapse correlated with a shorter time to progression of the disease [ 29 ]. Similarly, variant growth patterns of NLPHL were found to be associated with a higher stage and lower complete response and more frequent relapse rates in the pediatric age group [ 30 ].…”

“…We previously identified variant immunoarchitectural growth patterns in NLPHL that correlated with disease recurrence and progression [ 27 ]. The prognostic relevance of these variant patterns was confirmed in independent adult and pediatric patient cohorts [ 28 , 29 , 30 ], and has been incorporated into the World Health Organization (WHO) classification of NLPHL and by the National Comprehensive Cancer Network (NCCN) clinical practice guidelines [ 4 , 10 ]. The underlying changes responsible for the altered growth characteristics are poorly understood.…”

Molecular Update and Evolving Classification of Large B-Cell Lymphoma

“…T cell/histiocyte-rich large B cell lymphoma (THRLBCL) is an uncommon and aggressive variant of DLBCL [2], presenting with advanced stage disease and frequent spleen and liver involvement cells [2,91] in middle-age patients.…”