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

Michael S. Binkley, M. Shahzad Rauf, Sarah A. Milgrom, Chelsea C. Pinnix, Richard Tsang, Michael Dickinson, Andrea K. Ng, Kenneth B. Roberts, Sarah Gao, Alex Balogh, Umberto Ricardi, Mario Levis, Carla Casulo, Michael Stolten, Lena Specht, John P. Plastaras, Christopher Wright, Christopher R. Kelsey, Jessica L. Brady, N. George MikhaeelBradford S. Hoppe, Stephanie A. Terezakis, Marco Picardi, Roberta Della Pepa, Youlia Kirova, Saad Akhtar, Irfan Maghfoor, Julie L. Koenig, Christopher Jackson, Erin Song, Shuchi Sehgal, Ranjana H. Advani, Yasodha Natkunam, Louis S. Constine, Hans T. Eich, Andrew Wirth, Richard T. Hoppe

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2365-2374
Number of pages10
JournalBlood
Volume135
Issue number26
DOIs
StatePublished - Jun 25 2020

Bibliographical note

Publisher Copyright:
© 2020 by The American Society of Hematology

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