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Binkley MS, Advani RH. Treatment approaches for nodular lymphocyte-predominant Hodgkin lymphoma. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2023:S2152-2650(23)00111-8. [PMID: 37076366 DOI: 10.1016/j.clml.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/14/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare variant of Hodgkin lymphoma characterized by a persistent risk of relapse but an excellent overall survival. Historically, it was treated similarly to classic Hodgkin lymphoma, but efforts have been made to deintensify treatment due to risk of late toxicity associated with intensive therapy. For patients with completely resected stage IA NLPHL, no further treatment may be considered, particularly for pediatric patients. For those with stage I-II NLPHL without risk factors such as B symptoms, sites>2, or variant pattern histology, lower intensity treatment with radiotherapy or chemotherapy alone may be sufficient. However, combined modality therapy is a standard treatment for favorable and unfavorable risk stage I-II NLPHL associated with excellent progression-free and overall survival rates. For patients with advanced stage NLPHL, the optimal chemotherapy is not defined, but R-CHOP appears to be an effective treatment. Efforts to study NLPHL through multicenter collaborative efforts are crucial to develop evidence based and individualized treatments for patients with NLPHL.
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Affiliation(s)
- Michael S Binkley
- Department of Radiation Oncology, Stanford University, Palo Alto, CA.
| | - Ranjana H Advani
- Department of Medicine, Division of Oncology, Stanford University, Palo Alto, CA
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2
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Rauf MS, Khan ZA, Zahir MN, Al-Sweedan S, Al-Kofide A, Alharthy H, Almugbel FA, Osmani A, Elhassan TAM, Khafaga Y, Maghfoor I, Akhtar S. Comparison of 18F-labelled fluoro-2-deoxyglucose-PET with conventional computed tomography for staging and response assessment in paediatric and adult patients with nodular lymphocyte-predominant Hodgkin's lymphoma. Nucl Med Commun 2021; 42:899-906. [PMID: 33852535 DOI: 10.1097/mnm.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is an uncommon subtype of Hodgkin lymphoma. Data are limited regarding 18F-labelled fluoro-2-deoxyglucose (FDG)-PET use in NLPHL. We are reporting our experience with FDG-PET utility in staging and response assessment NLPHL patients. METHODS We retrospectively studied a population of all newly diagnosed or relapsed/refractory patients who underwent both pre-treatment contrast-enhanced computed tomography (CeCT) and an FDG-PET and also at the end of planned treatment. RESULTS We identified 68 patients found to have in total 312 scans, 78 paired pre-therapeutic and post-treatment CeCT and FDG-PET scans. Among them, 55 were male, with a median follow-up was 48 months. Median SUV-max was 8.3 (2.0-21.0). FDG-PET and CeCT were concordant in 80% (62/78) of staging scans. In 20% (16/78) of patients in whom a discordance was observed, FDG-PET resulted in upstaging in 13 scans and downstaging in 3 scans. The sensitivity of CeCT was 92% for nodal staging and 42% for extralymphatic staging when compared to FDG-PET. The specificity of CeCT was 98% as compared to FDG-PET. For response assessment, there was poor agreement between the CeCT and FDG-PET in assigning complete remission of disease scores as FDG-PET was able to identify the absence of disease despite the presence of a radiologically evident residual mass on CeCT. The sensitivity for CeCT compared to FDG-PET was 100% while the specificity was 43% for detection of post-treatment response. CONCLUSION For NLPHL, pre-therapeutic FDG-PET scan is better than CeCT staging. FDG-PET has much better specificity for response assessment than CeCT.
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Affiliation(s)
- M Shahzad Rauf
- Medical Oncology Department, King Abdullah Centre for Oncology and Liver Diseases
| | - Z A Khan
- Nuclear Medicine/Radiology Department
| | - M N Zahir
- Medical Oncology Department, King Abdullah Centre for Oncology and Liver Diseases
| | | | | | - Hannan Alharthy
- Medical Oncology Department, King Abdullah Centre for Oncology and Liver Diseases
| | - Fahad A Almugbel
- Medical Oncology Department, King Abdullah Centre for Oncology and Liver Diseases
| | - Asif Osmani
- Medical Oncology Department, King Abdullah Centre for Oncology and Liver Diseases
| | | | - Yasser Khafaga
- Radiation Oncology Department, King Abdullah Centre for Oncology and Liver Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Irfan Maghfoor
- Medical Oncology Department, King Abdullah Centre for Oncology and Liver Diseases
| | - Saad Akhtar
- Medical Oncology Department, King Abdullah Centre for Oncology and Liver Diseases
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Salvioni Chiabotti P, Bisig B, Cairoli A, Hajdu SD, Lovey PY, Milowich D, Ziadi S, Du Pasquier R, Brouland JP, de Leval L. Meningeal Relapse of Nodular Lymphocyte Predominant Hodgkin Lymphoma Transformed to T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: A Case Report. Front Oncol 2020; 10:1745. [PMID: 33042818 PMCID: PMC7521157 DOI: 10.3389/fonc.2020.01745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/04/2020] [Indexed: 11/21/2022] Open
Abstract
Central nervous system involvement in Hodgkin lymphoma is extremely rare, especially in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL), which usually carries a favorable prognosis. Here we report a case of a young patient with NLPHL, who developed a progressive and fatal neurological deterioration requiring a very extensive work-up including two biopsies to obtain the diagnosis of T-cell/histiocyte-rich large B-cell lymphoma like transformation. This report, which includes post-mortem analysis, highlights the correlations between clinical, radiological, and biological data but also the difficulties encountered in reaching the correct diagnosis.
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Affiliation(s)
- Paolo Salvioni Chiabotti
- Department of Clinical Neurosciences, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bettina Bisig
- Department of Laboratory Medicine and Pathology, Institute of Pathology, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne Cairoli
- Department of Oncology, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Steven D Hajdu
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Dina Milowich
- Department of Laboratory Medicine and Pathology, Institute of Pathology, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sonia Ziadi
- Department of Laboratory Medicine and Pathology, Institute of Pathology, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Renaud Du Pasquier
- Department of Clinical Neurosciences, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Philippe Brouland
- Department of Laboratory Medicine and Pathology, Institute of Pathology, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
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Alessandrino F, DiPiro PJ, Jagannathan JP, Babina G, Krajewski KM, Ramaiya NH, Giardino AA. Multimodality imaging of indolent B cell lymphoma from diagnosis to transformation: what every radiologist should know. Insights Imaging 2019; 10:25. [PMID: 30796644 PMCID: PMC6386758 DOI: 10.1186/s13244-019-0705-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022] Open
Abstract
Indolent B cell lymphomas are a group of lymphoid malignancies characterized by their potential to undergo histologic transformation to aggressive lymphomas. While different subtypes of indolent B cell lymphomas demonstrate specific clinical and imaging features, histologic transformation can be suspected on cross-sectional imaging when disproportionate lymph node enlargement or new focal lesions in extranodal organs are seen. On PET/CT, transformed indolent lymphoma may show new or increased nodal FDG avidity or new FDG-avid lesions in different organs. In this article, we will (1) review the imaging features of different subtypes of indolent B cell lymphomas, (2) discuss the imaging features of histologic transformation, and (3) propose a diagnostic algorithm for transformed indolent lymphoma. The purpose of this review is to familiarize radiologists with the spectrum of clinical and imaging features of indolent B cell lymphomas and to define the role of imaging in raising concern for transformation and in guiding biopsy for confirmation.
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Affiliation(s)
- Francesco Alessandrino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Pamela J DiPiro
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jyothi P Jagannathan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Gosangi Babina
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Katherine M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Nikhil H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Angela A Giardino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Shankar AG, Kirkwood AA, Depani S, Bianchi E, Hayward J, Ramsay AD, Hall GW. Relapsed or poorly responsive nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents - a report from the United Kingdom's Children's Cancer and Leukaemia Study Group. Br J Haematol 2016; 173:421-31. [PMID: 26996288 DOI: 10.1111/bjh.13979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/21/2015] [Indexed: 01/02/2023]
Abstract
There is a paucity of data on the treatment outcome in children with relapsed or poorly responsive nodular lymphocyte predominant Hodgkin lymphoma (nLPHL). This retrospective report evaluates the treatment outcome in a national cohort of children with relapsed or poorly responsive nLPHL. A total of 37 patients, 22 with relapsed and 15 with poorly responding disease, are the subjects of this report. Of the 22 patients with relapsed nLPHL, 11 had relapsed after primary excision biopsy, 10 after chemotherapy and 1 after chemotherapy and involved field radiotherapy. The majority had localized disease at relapse. The median time to relapse was 8 months after chemotherapy and 11 months after excision biopsy. Seven of the 15 patients with poorly responding nLPHL had variant histology. Three patients with initial poor response did not receive any further treatment and have had no disease progression. Transformation to diffuse large B cell lymphoma, in addition to evolution from typical to variant nLPHL occurred in one patient each. Thirty-four patients have been successfully re-treated with second chemotherapy or radiotherapy. Multiple relapses were uncommon but treatable. Relapse or poorly responsive nLPHL is fully salvageable with either additional chemotherapy and or radiotherapy.
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Affiliation(s)
- Ananth G Shankar
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Sarita Depani
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eleonora Bianchi
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Janis Hayward
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Alan D Ramsay
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgina W Hall
- Department of Paediatric Oncology and Haematology, Children's Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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McKay P, Fielding P, Gallop-Evans E, Hall GW, Lambert J, Leach M, Marafioti T, McNamara C. Guidelines for the investigation and management of nodular lymphocyte predominant Hodgkin lymphoma. Br J Haematol 2015; 172:32-43. [PMID: 26538004 DOI: 10.1111/bjh.13842] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Pamela McKay
- Department of Haematology; Beatson West of Scotland Cancer Centre; Gartnavel Hospital; Glasgow UK
| | - Patrick Fielding
- PETIC; Department of Radiology; University Hospital of Wales; Cardiff UK
| | - Eve Gallop-Evans
- Department of Clinical Oncology; Velindre Cancer Centre; Cardiff UK
| | - Georgina W. Hall
- Paediatric Haematology/Oncology Unit; Children's Hospital; John Radcliffe Hospital; Headington Oxford
| | - Jonathan Lambert
- Department of Haematology; University College London Hospitals; London UK
| | - Mike Leach
- Department of Haematology; Beatson West of Scotland Cancer Centre; Gartnavel Hospital; Glasgow UK
| | - Teresa Marafioti
- Department of Pathology; University College London Hospitals; London UK
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