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Binkley MS, Flerlage JE, Savage KJ, Akhtar S, Steiner R, Zhang XY, Dickinson M, Prica A, Major A, Hendrickson PG, Hopkins D, Ng A, Casulo C, Baron J, Roberts KB, Al Kendi J, Balogh A, Ricardi U, Torka P, Specht L, De Silva R, Pickard K, Blazin LJ, Henry M, Smith CM, Halperin D, Brady J, Brennan B, Senchenko MA, Reeves M, Hoppe BS, Terezakis S, Talaulikar D, Picardi M, Kirova Y, Fergusson P, Hawkes EA, Lee D, Doo NW, Barraclough A, Cheah CY, Ku M, Hamad N, Mutsando H, Gilbertson M, Marconi T, Viiala N, Maurer MJ, Eichenauer DA, Hoppe RT. International Prognostic Score for Nodular Lymphocyte-Predominant Hodgkin Lymphoma. J Clin Oncol 2024; 42:2271-2280. [PMID: 38531001 DOI: 10.1200/jco.23.01655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 01/11/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare cancer, and large international cooperative efforts are needed to evaluate the significance of clinical risk factors and immunoarchitectural patterns (IAPs) for all stages of pediatric and adult patients with NLPHL. METHODS Thirty-eight institutions participated in the Global nLPHL One Working Group retrospective study of NLPHL cases from 1992 to 2021. We measured progression-free survival (PFS), overall survival (OS), transformation rate, and lymphoma-specific death rate. We performed uni- and multivariable (MVA) Cox regression stratified by management to select factors for the lymphocyte-predominant international prognostic score (LP-IPS) validated by five-fold cross-validation. RESULTS We identified 2,243 patients with a median age of 37 years (IQR, 23-51). The median follow-up was 6.3 years (IQR, 3.4-10.8). Most had stage I to II (72.9%) and few B symptoms (9.9%) or splenic involvement (5.4%). IAP was scored for 916 (40.8%). Frontline management included chemotherapy alone (32.4%), combined modality therapy (30.5%), radiotherapy alone (24.0%), observation after excision (4.6%), rituximab alone (4.0%), active surveillance (3.4%), and rituximab and radiotherapy (1.1%). The PFS, OS, transformation, and lymphoma-specific death rates at 10 years were 70.8%, 91.6%, 4.8%, and 3.3%, respectively. On MVA, IAPs were not associated with PFS or OS, but IAP E had higher risk of transformation (hazard ratio [HR], 1.81; P < .05). We developed the LP-IPS with 1 point each for age ≥45 years, stage III-IV, hemoglobin <10.5 g/dL, and splenic involvement. Increasing LP-IPS was significantly associated with worse PFS (HR, 1.52) and OS (HR, 2.31) and increased risk of lymphoma-specific death (HR, 2.63) and transformation (HR, 1.41). CONCLUSION In this comprehensive study of all ages of patients with NLPHL, we develop the LP-IPS to identify high-risk patients and inform upcoming prospective clinical trials evaluating de-escalation of therapy for patients with low LP-IPS scores (<2).
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Affiliation(s)
- Michael Sargent Binkley
- Department of Radiation Oncology, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Jamie E Flerlage
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Saad Akhtar
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Raphael Steiner
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Anca Prica
- Princess Margaret Cancer Centre, Toronto, Canada
| | | | | | - David Hopkins
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Andrea Ng
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lena Specht
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Ravindu De Silva
- Norfolk and Norwich University Hospital, Norfolk, United Kingdom
| | - Keir Pickard
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Lindsay J Blazin
- Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Daniel Halperin
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Jessica Brady
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Maria Anatolevna Senchenko
- Oncology and Immunology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Moscow, Russian Federation
| | - Marie Reeves
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Bradford S Hoppe
- University of Florida, Gainesville, FL
- Mayo Clinic, Jacksonville, FL
| | | | - Dipti Talaulikar
- Canberra Health Services, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, AOU Federico II, Naples, Italy
| | | | | | - Eliza A Hawkes
- Olivia Newton-John Cancer Research Centre at Austin Health, Melbourne, Australia
- Lymphoma and Related Diseases Registry, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise Lee
- Austin Hospital, Eastern Health, Melbourne, Australia
| | - Nicole Wong Doo
- Lymphoma and Related Diseases Registry, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Concord Hospital, Concord Clinical School, University of Sydney, Sydney, Australia
| | | | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, Australia
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Howard Mutsando
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- University of Queensland Rural Clinical School, Toowoomba, Australia
| | | | | | - Nicholas Viiala
- Department of Haematology, Liverpool Hospital, Liverpool, Australia
- South West Sydney Clinical School, UNSW Medicine, Liverpool, Australia
| | - Matthew J Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Dennis A Eichenauer
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, German Hodgkin Study Group, Cologne, Germany
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford School of Medicine, Stanford University, Stanford, CA
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Ballas LK, Metzger ML, Milgrom SA, Advani R, Bakst RL, Dabaja BS, Flowers CR, Ha CS, Hoppe BS, Mansur DB, Pinnix CC, Plastaras JP, Roberts KB, Smith SM, Terezakis SA, Constine LS. Nodular lymphocyte predominant Hodgkin lymphoma: executive summary of the American radium society appropriate use criteria. Leuk Lymphoma 2020; 62:1057-1065. [DOI: 10.1080/10428194.2020.1852559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Leslie K. Ballas
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Monika L. Metzger
- St Jude Children’s Research Hospital, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | | | | | | | | | | | - Chul S. Ha
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - David B. Mansur
- University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Eichenauer DA, Engert A. Nodular lymphocyte-predominant Hodgkin lymphoma: a unique disease deserving unique management. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:324-328. [PMID: 29222274 PMCID: PMC6142570 DOI: 10.1182/asheducation-2017.1.324] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma entity with an incidence of 0.1 to 0.2/100 000/y. Compared with the more common subtypes of classical Hodgkin lymphoma, NLPHL is characterized by distinct pathological and clinical features. Histologically, the disease-defining lymphocyte predominant cells consistently express CD20 but lack CD30. Clinically, NLPHL mostly has a rather indolent course, and patients usually are diagnosed in early stages. The prognosis of early-stage NLPHL is excellent, with progression-free survival and overall survival rates exceeding 90% after involved-field radiotherapy (IF-RT) alone (stage IA) or combined modality treatment consisting of a brief chemotherapy with 2 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy followed by IF-RT (early stages other than stage IA). In contrast, patients with advanced disease at diagnosis tend to relapse either with NLPHL histology or with histological transformation into aggressive B-cell non-Hodgkin lymphoma despite more aggressive first-line treatment with 6 to 8 cycles of multiagent chemotherapy. However, even NLPHL patients with multiple relapses successfully respond to salvage therapy in many cases. Salvage therapies range from single-agent anti-CD20 antibody treatment to high-dose chemotherapy followed by autologous stem cell transplantation. Treatment at disease recurrence should be chosen on the basis of various factors, including histology at relapse, time to relapse, extent of disease at relapse, and prior treatment. Because death among NLPHL patients is more often caused by therapy-related late effects than lymphoma-related complications, optimizing the risk-benefit ratio of treatment by decreasing toxicity whenever possible is the major goal of clinical research in this disease.
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Affiliation(s)
- Dennis A. Eichenauer
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany; and
- German Hodgkin Study Group, Cologne, Germany
| | - Andreas Engert
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany; and
- German Hodgkin Study Group, Cologne, Germany
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Moiseeva TN, Al-Radi LS, Kovrigina AM, Goryacheva SR, Julakyan UL, Margolin OV, Skidan NI, Tseytlina MA, Kravchenko SK. [Nodular lymphocyte-predominant Hodgkin's lymphoma: Principles of diagnosis and treatment]. TERAPEVT ARKH 2016; 87:78-83. [PMID: 26821421 DOI: 10.17116/terarkh2015871178-83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To describe the clinical and morphological features of the rare Hodgkin's lymphoma (HL) subtype--nodular lymphocyte-predominant HL (NLPHL). SUBJECTS AND METHODS Forty-two patients were diagnosed with NLPHL in 2010 to 2014. The male to female ratio was 2.2:1; the median age was 37 years (range 17-68 years). NLPHL was diagnosed on the basis of the histological and immunohistochemical examinations of tumor biopsy specimens; disease stages were determined by standard HL studies. RESULTS Before NLPHL was detected, 23 (55%) patients were diagnosed as having HL in 13 cases, follicular lymphoma in 2, lymphofollicular hyperplasia in 3, angioimmunoblastic lymphoma in 1, diffuse large B-cell lymphoma in 3, and B-cell lymphoma (non-HL) in 1. Long-term (3-21-year; median 8 years) persistent lymphadenopathy was observed in 16 (38%) patients. Seventeen (40.5%) patients had early (I-II) stages of the disease and 25 (59.5%) had advanced stages. B symptoms were noted in 24% of cases. There was involvement of extranodal sites (salivary gland, tonsil) in 2 patients, spleen in 14 (33%), bone marrow in 8, and bulky disease in 2. Cycles of ABVD ± rituximab ± radiotherapy (RT) were used in early-stage NLPHL; those of R-BEACOPP-14 ± RT were performed in the advanced stages of the disease or its transformation to diffuse large B-cell lymphoma with excessive T cells. CONCLUSION When patients have a history of long-term asymptomatic lymphadenopathy, it is necessary to rule out NLPHL, for which purpose an immunohistochemical examination of a biopsy specimen and its reexamination in a laboratory having experience in diagnosing NLPHL must necessarily be done. Lower RT doses and rituximab incorporated into the cycle of treatment are indicated to reduce its toxicity and to preserve therapeutic efficiency.
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Affiliation(s)
- T N Moiseeva
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - L S Al-Radi
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - A M Kovrigina
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - S R Goryacheva
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - U L Julakyan
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - O V Margolin
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - N I Skidan
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - M A Tseytlina
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - S K Kravchenko
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
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Eichenauer DA, Plütschow A, Fuchs M, von Tresckow B, Böll B, Behringer K, Diehl V, Eich HT, Borchmann P, Engert A. Long-Term Course of Patients With Stage IA Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the German Hodgkin Study Group. J Clin Oncol 2015; 33:2857-62. [DOI: 10.1200/jco.2014.60.4363] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The optimal treatment of stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is not well defined. Thus, we performed an analysis using the database of the German Hodgkin Study Group. Patients and Methods The long-term outcome of 256 patients with stage IA NLPHL was evaluated. Patients had received combined-modality treatment (CMT; n = 72), extended-field radiotherapy (EF-RT; n = 49), involved-field radiotherapy (IF-RT; n = 108), or four weekly standard doses of rituximab (n = 27) within German Hodgkin Study Group clinical trial protocols between 1988 and 2009. Results The median age at NLPHL diagnosis was 39 years (range, 16 to 75 years). Most patients were male (76%). The whole patient group had a median follow-up of 91 months (CMT: 95 months; EF-RT: 110 months; IF-RT: 87 months; rituximab: 49 months). At 8 years, progression-free survival and overall survival rates were 88.5% and 98.6% for CMT, 84.3% and 95.7% for EF-RT, and 91.9% and 99.0% for IF-RT, respectively. Patients treated with rituximab had 4-year progression-free and overall survival rates of 81.0% and 100%, respectively. A second malignancy during the course of follow-up was diagnosed in 17 (6.6%) of 256 patients. A total of 12 deaths occurred. However, only one patient died from NLPHL. Conclusion Tumor control in this analysis was equivalent with CMT, EF-RT, and IF-RT. Therefore, IF-RT, which is associated with the lowest risk for the development of toxic effects, should be considered as standard of care for patients with stage IA NLPHL. Rituximab alone is associated with an increased risk of relapse in this patient population.
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Affiliation(s)
- Dennis A. Eichenauer
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Annette Plütschow
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Michael Fuchs
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Bastian von Tresckow
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Boris Böll
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Karolin Behringer
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Volker Diehl
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Hans Theodor Eich
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Peter Borchmann
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Andreas Engert
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
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