Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is an uncommon histologic variant, and the optimal treatment of stage I-II NLPHL is undefined. We conducted a multicenter retrospective study including patients ≥16 years of age with stage I-II NLPHL diagnosed from 1995 through 2018 who underwent all forms of management, including radiotherapy (RT), combined modality therapy (CMT; RT+chemotherapy [CT]), CT, observation after excision, rituximab and RT, and single-agent rituximab. End points were progression-free survival (PFS), freedom from transformation, and overall survival (OS) without statistical comparison between management groups. We identified 559 patients with median age of 39 years: 72.3% were men, and 54.9% had stage I disease. Median follow-up was 5.5 years (interquartile range, 3.1-10.1). Five-year PFS and OS in the entire cohort were 87.1% and 98.3%, respectively. Primary management was RT alone (n = 257; 46.0%), CMT (n = 184; 32.9%), CT alone (n = 47; 8.4%), observation (n = 37; 6.6%), rituximab and RT (n = 19; 3.4%), and rituximab alone (n = 15; 2.7%). The 5-year PFS rates were 91.1% after RT, 90.5% after CMT, 77.8% after CT, 73.5% after observation, 80.8% after rituximab and RT, and 38.5% after rituximab alone. In the RT cohort, but not the CMT cohort, variant immunoarchitectural pattern and number of sites >2 were associated with worse PFS (P < .05). Overall, 21 patients (3.8%) developed large-cell transformation, with a significantly higher transformation rate in those with variant immunoarchitectural pattern (P = .049) and number of involved sites >2 (P = .0006). OS for patients with stage I-II NLPHL was excellent after all treatments.

Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG / Binkley, M. S.; Rauf, M. S.; Milgrom, S. A.; Pinnix, C. C.; Tsang, R.; Dickinson, M.; Ng, A. K.; Roberts, K. B.; Gao, S.; Balogh, A.; Ricardi, U.; Levis, M.; Casulo, C.; Stolten, M.; Specht, L.; Plastaras, J. P.; Wright, C.; Kelsey, C. R.; Brady, J. L.; Mikhaeel, N. G.; Hoppe, B. S.; Terezakis, S. A.; Picardi, M.; Della Pepa, R.; Kirova, Y.; Akhtar, S.; Maghfoor, I.; Koenig, J. L.; Jackson, C.; Song, E.; Sehgal, S.; Advani, R. H.; Natkunam, Y.; Constine, L. S.; Eich, H. T.; Wirth, A.; Hoppe, R. T.. - In: BLOOD. - ISSN 1528-0020. - 135:26(2020), pp. 2365-2374. [10.1182/blood.2019003877]

Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG

Picardi M.;Della Pepa R.;
2020

Abstract

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is an uncommon histologic variant, and the optimal treatment of stage I-II NLPHL is undefined. We conducted a multicenter retrospective study including patients ≥16 years of age with stage I-II NLPHL diagnosed from 1995 through 2018 who underwent all forms of management, including radiotherapy (RT), combined modality therapy (CMT; RT+chemotherapy [CT]), CT, observation after excision, rituximab and RT, and single-agent rituximab. End points were progression-free survival (PFS), freedom from transformation, and overall survival (OS) without statistical comparison between management groups. We identified 559 patients with median age of 39 years: 72.3% were men, and 54.9% had stage I disease. Median follow-up was 5.5 years (interquartile range, 3.1-10.1). Five-year PFS and OS in the entire cohort were 87.1% and 98.3%, respectively. Primary management was RT alone (n = 257; 46.0%), CMT (n = 184; 32.9%), CT alone (n = 47; 8.4%), observation (n = 37; 6.6%), rituximab and RT (n = 19; 3.4%), and rituximab alone (n = 15; 2.7%). The 5-year PFS rates were 91.1% after RT, 90.5% after CMT, 77.8% after CT, 73.5% after observation, 80.8% after rituximab and RT, and 38.5% after rituximab alone. In the RT cohort, but not the CMT cohort, variant immunoarchitectural pattern and number of sites >2 were associated with worse PFS (P < .05). Overall, 21 patients (3.8%) developed large-cell transformation, with a significantly higher transformation rate in those with variant immunoarchitectural pattern (P = .049) and number of involved sites >2 (P = .0006). OS for patients with stage I-II NLPHL was excellent after all treatments.
2020
Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG / Binkley, M. S.; Rauf, M. S.; Milgrom, S. A.; Pinnix, C. C.; Tsang, R.; Dickinson, M.; Ng, A. K.; Roberts, K. B.; Gao, S.; Balogh, A.; Ricardi, U.; Levis, M.; Casulo, C.; Stolten, M.; Specht, L.; Plastaras, J. P.; Wright, C.; Kelsey, C. R.; Brady, J. L.; Mikhaeel, N. G.; Hoppe, B. S.; Terezakis, S. A.; Picardi, M.; Della Pepa, R.; Kirova, Y.; Akhtar, S.; Maghfoor, I.; Koenig, J. L.; Jackson, C.; Song, E.; Sehgal, S.; Advani, R. H.; Natkunam, Y.; Constine, L. S.; Eich, H. T.; Wirth, A.; Hoppe, R. T.. - In: BLOOD. - ISSN 1528-0020. - 135:26(2020), pp. 2365-2374. [10.1182/blood.2019003877]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/823876
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