1
|
Eyre TA, Gatter K, Collins GP, Hall GW, Watson C, Hatton CS. Incidence, management, and outcome of high-grade transformation of nodular lymphocyte predominant Hodgkin lymphoma: long-term outcomes from a 30-year experience. Am J Hematol 2015; 90:E103-10. [PMID: 25715900 DOI: 10.1002/ajh.23989] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 12/19/2022]
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare form of Hodgkin lymphoma that typically presents as early stage, indolent disease in young adult males. The relationship between NLPHL and DLBCL is incompletely understood, and there remains a paucity of data with regard the incidence and management of high-grade transformation. We report the largest study to date describing the incidence, management and long-term outcome of 26 cases of high-grade transformation of NLPHL over a 30-year period. We report a transformation incidence of 17.0%. Bone marrow, splenic, and liver infiltration with DLBCL was frequent. Patients with an aa-IPI 2-3 have poorer OS and PFS (P = 0.034 and P = 0.009, respectively). Although the approach to treatment was somewhat variable, typically young, otherwise fit patients received anthracycline-based induction, platinum-based consolidation with stem cell harvesting, followed by autologous SCT with BEAM conditioning. Long-term (5 year) PFS was over 60% with this approach, and comparable to our de novo DLBCL historical age and time period-matched cohort largely treated with CHOP-like chemotherapy alone. The transformation rate of 17.0% highlights the importance of accurate initial diagnosis, long-term follow-up, and re-biopsy at relapse.
Collapse
Affiliation(s)
- Toby A. Eyre
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Kevin Gatter
- Nuffield Division of Clinical Laboratory Sciences; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Graham P. Collins
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Georgina W. Hall
- Paediatric Haematology & Oncology Unit; Children's Hospital; John Radcliffe Hospital, Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Caroline Watson
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Chris S.R. Hatton
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| |
Collapse
|
2
|
Jackson C, Sirohi B, Cunningham D, Horwich A, Thomas K, Wotherspoon A. Lymphocyte-predominant Hodgkin lymphoma—clinical features and treatment outcomes from a 30-year experience. Ann Oncol 2010; 21:2061-2068. [DOI: 10.1093/annonc/mdq063] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
3
|
Chen RC, Chin MS, Ng AK, Feng Y, Neuberg D, Silver B, Pinkus GS, Stevenson MA, Mauch PM. Early-Stage, Lymphocyte-Predominant Hodgkin's Lymphoma: Patient Outcomes From a Large, Single-Institution Series With Long Follow-Up. J Clin Oncol 2010; 28:136-41. [DOI: 10.1200/jco.2009.24.0945] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The optimal treatment for early-stage, lymphocyte-predominant Hodgkin's lymphoma (LPHL) is not well defined. Treatment has become less aggressive over time in an attempt to reduce iatrogenic complications, such as cardiac mortality and second cancers, but long-term efficacy is unclear. We present the long-term outcome of patients treated at a single institution. Patients and Methods The study population includes 113 patients with stage I or II LPHL treated between 1970 and 2005. Pathologic diagnosis for all patients was confirmed using standard criteria. Ninety-three patients received radiation therapy (RT) alone, 13 received RT with chemotherapy, and seven received chemotherapy alone. Among patients treated with RT, 25 received limited-field, 35 received regional-field, and 46 received extended-field RT. Results Median follow-up was 136 months. Ten-year progression-free survival (PFS) rates were 85% (stage I) and 61% (stage II); overall survival (OS) rates were 94% and 97% for stages I and II, respectively. PFS and OS did not differ among patients who received limited-field, regional-field, or extended-field RT. In contrast, six of seven patients who received chemotherapy alone without RT developed early disease progression and required salvage treatment. Multivariable analysis adjusting for extent of RT, clinical stage, sex, and use of chemotherapy confirmed that the extent of RT was not significantly associated with PFS (P = .67) or OS (P = .99). The addition of chemotherapy to RT did not improve PFS or OS compared with RT alone. Conclusion RT alone leads to sustained disease control and high long-term survival rates in patients with early-stage LPHL. This study supports the use of limited-field RT alone to treat this disease.
Collapse
Affiliation(s)
- Ronald C. Chen
- From the Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute; Department of Pathology, Brigham and Women's Hospital; Harvard Radiation Oncology Program; and Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston; and University of Massachusetts Medical School, Worcester, MA
| | - Michael S. Chin
- From the Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute; Department of Pathology, Brigham and Women's Hospital; Harvard Radiation Oncology Program; and Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston; and University of Massachusetts Medical School, Worcester, MA
| | - Andrea K. Ng
- From the Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute; Department of Pathology, Brigham and Women's Hospital; Harvard Radiation Oncology Program; and Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston; and University of Massachusetts Medical School, Worcester, MA
| | - Yang Feng
- From the Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute; Department of Pathology, Brigham and Women's Hospital; Harvard Radiation Oncology Program; and Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston; and University of Massachusetts Medical School, Worcester, MA
| | - Donna Neuberg
- From the Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute; Department of Pathology, Brigham and Women's Hospital; Harvard Radiation Oncology Program; and Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston; and University of Massachusetts Medical School, Worcester, MA
| | - Barbara Silver
- From the Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute; Department of Pathology, Brigham and Women's Hospital; Harvard Radiation Oncology Program; and Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston; and University of Massachusetts Medical School, Worcester, MA
| | - Geraldine S. Pinkus
- From the Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute; Department of Pathology, Brigham and Women's Hospital; Harvard Radiation Oncology Program; and Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston; and University of Massachusetts Medical School, Worcester, MA
| | - Mary Ann Stevenson
- From the Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute; Department of Pathology, Brigham and Women's Hospital; Harvard Radiation Oncology Program; and Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston; and University of Massachusetts Medical School, Worcester, MA
| | - Peter M. Mauch
- From the Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute; Department of Pathology, Brigham and Women's Hospital; Harvard Radiation Oncology Program; and Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston; and University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
4
|
|
5
|
Haas RL, Girinsky T, Aleman BM, Henry-Amar M, de Boer JP, de Jong D. Low-Dose Involved-Field Radiotherapy as Alternative Treatment of Nodular Lymphocyte Predominance Hodgkin's Lymphoma. Int J Radiat Oncol Biol Phys 2009; 74:1199-202. [DOI: 10.1016/j.ijrobp.2008.09.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 09/02/2008] [Accepted: 09/05/2008] [Indexed: 12/11/2022]
|
6
|
Huang JZ, Weisenburger DD, Vose JM, Greiner TC, Aoun P, Chan WC, Lynch JC, Bierman PJ, Armitage JO. Diffuse Large B-cell Lymphoma Arising in Nodular Lymphocyte Predominant Hodgkin Lymphoma. A Report of 21 Cases from the Nebraska Lymphoma Study Group. Leuk Lymphoma 2009; 44:1903-10. [PMID: 14738141 DOI: 10.1080/1042819031000123528] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We sought to investigate the clinical characteristics and pathologic features and survival outcome of patients with diffuse large B-cell lymphoma (DLBCL) arising in nodular lymphocyte predominant Hodgkin's disease (NLPHL), since controversy regarding their prognosis exists in the literature. Twenty-one patients with DLBCL arising either concurrently with (n = 7) or subsequent to (n = 14) a diagnosis of NLPHL were identified in the Nebraska Lymphoma Study Group Registry. The clinical and pathologic features of the cases were evaluated, and survival analysis was performed from the time of diagnosis of DLBCL. The median time to the development of DLBCL in those with prior NLPHL was only one year (range, 0.5-24 years). The median age of the patients at the time of diagnosis of DLBCL was 46 years (range, 18-72 years) and the male to female ratio was 17:4. Ten patients presented with nodal DLBCL only, six patients presented with both nodal and extranodal involvement, and five patients presented with only extranodal DLBCL. Eleven patients had limited stage (I/II) disease and 10 had advanced stage (III/IV) disease. The median overall survival (OS) and failure-free survival (FFS) of the entire group was 35 months and 11 months, respectively, and the predicted five-year OS and FFS was 31 and 18%, respectively. There were no significant differences in the survival outcomes between patients with DLBCL arising in NLPHL and age- and sex- matched patients with de novo DLBCL. In conclusion, our findings suggest that patients with DLBCL arising in NLPHL have a prognosis similar to those with de novo DLBCL and should be treated aggressively.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Case-Control Studies
- Female
- Hodgkin Disease/drug therapy
- Hodgkin Disease/pathology
- Humans
- Incidence
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Nebraska
- Neoplasm Staging
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/pathology
- Prognosis
- Survival Rate
Collapse
Affiliation(s)
- James Z Huang
- Department of Pathology, University of Nebraska Medical Center, Omaha, NE, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Clinical Presentation and Outcomes of Lymphocyte-predominant Hodgkin Disease at the University of Florida. Am J Clin Oncol 2007; 30:601-6. [DOI: 10.1097/coc.0b013e318145b9db] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), a distinct subtype of Hodgkin lymphoma, is a rare disease with a generally favorable prognosis. The hallmark of NLPHL is the presence of the lymphocytic and histiocytic cell, which, in contrast to the classic Reed-Sternberg cell, is CD20+, CD15-, and CD30-. NLPHL tends to have an indolent natural history, a long time to disease progression, a delayed time to relapse, and a high likelihood of presenting as early-stage disease. The evidence to guide the management of patients with NLPHL is limited by the rarity of this disease, but the available data support the use of involved-field radiation therapy alone for localized disease. Treatment-related late effects contribute significantly to the causes of death in patients treated for NLPHL.
Collapse
Affiliation(s)
- Henry K Tsai
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115
| | | |
Collapse
|
9
|
Wirth A, Yuen K, Barton M, Roos D, Gogna K, Pratt G, Macleod C, Bydder S, Morgan G, Christie D. Long-term outcome after radiotherapy alone for lymphocyte-predominant Hodgkin lymphoma. Cancer 2005; 104:1221-9. [PMID: 16094666 DOI: 10.1002/cncr.21303] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The curative potential of radiotherapy (RT) alone as initial treatment for patients with Stage I-II lymphocyte-predominant Hodgkin lymphoma (LPHL) has not been defined well. METHODS Two hundred two patients who were treated between 1969 and 1995 were evaluated in a retrospective, multicenter study. RESULTS Patient characteristics were as follows: The median age was 31 years, 75% of patients were male, 80% of patients had Ann Arbor Stage I disease, 1% of patients had bulky disease, 3% of patients had B symptoms, 1% of patients had extranodal involvement, and 80% of patients had supradiaphragmatic disease. The RT fields were a full mantle field in 52% of patients, less than a full mantle field in 24% of patients, an inverted-Y field in 17% of patients, less than an inverted-Y field in 3% of patients, and total lymph node irradiation in 3% of patients. The median dose was 36 Gray. The median follow-up was 15 years. The overall survival (OS) rate at 15 years was 83%, and freedom from progression (FFP) was observed in 82% of patients, including 84% of patients with Stage I disease and 73% of patients with Stage II disease. No recurrent LPHL and only 1 patient with non-Hodgkin lymphoma (NHL) were reported after 15 years. Adverse prognostic factors that were identified on multifactor analysis were as follows: for OS, age 45 years or older (P < 0.0005), the presence of B symptoms (P = 0.002), increasing number of sites (P = 0.015); for FFP, increasing number of sites (P = 0.002). No significant difference was found in FFP in a comparison of patients who received elective mediastinal RT with patients who did not receive mediastinal RT (P = 0.11). Causes of death at 15 years were LPHL in 3% of patients, NHL in 2% of patients, in-field malignancy in 2% of patients, in-field cardiac/respiratory in 4% of patients, and other in 6% of patients. CONCLUSIONS The current data suggested that RT potentially may be curative for patients with Stage I-II LPHL and raise the possibility that limited-field RT may be used without loss of treatment efficacy. Involved-field RT warrants further investigation for patients with early-stage LPHL.
Collapse
Affiliation(s)
- Andrew Wirth
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Pellegrino B, Terrier-Lacombe MJ, Oberlin O, Leblanc T, Perel Y, Bertrand Y, Beard C, Edan C, Schmitt C, Plantaz D, Pacquement H, Vannier JP, Lambilliote C, Couillault G, Babin-Boilletot A, Thuret I, Demeocq F, Leverger G, Delsol G, Landman-Parker J. Lymphocyte-predominant Hodgkin's lymphoma in children: therapeutic abstention after initial lymph node resection--a Study of the French Society of Pediatric Oncology. J Clin Oncol 2003; 21:2948-52. [PMID: 12885814 DOI: 10.1200/jco.2003.01.079] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To clarify treatment strategy for lymphocyte-predominant Hodgkin's lymphoma (LPHL), the French Society of Pediatric Oncology initiated a prospective, nonrandomized study in 1988. Patients received either standard treatment for Hodgkin's lymphoma or were not treated beyond initial adenectomy. PATIENTS AND METHODS From 1988 to 1998, 27 patients were available for study. Twenty-four patients were male, and median age was 10 years (range, 4 to 16 years). Twenty-two, two, and three patients had stage I, II, and III disease, respectively. Thirteen patients (stage I, n = 11; stage III, n = 2) received no further treatment after initial surgical adenectomy (SA). Fourteen patients received combined treatment (CT; n = 10), involved-field radiotherapy alone (n = 1), or chemotherapy alone (n = 3). The two groups were comparable for clinical status, treatment, and follow-up. RESULTS Twenty-three of 27 patients achieved complete remission (CR). With a median follow-up time of 70 months (range, 32 to 214 months), overall survival to date is 100%, and overall event-free survival (EFS) is 69% +/- 10% (SA, 42% +/- 16%; CT, 90% +/- 8.6%; P <.04). If we considered only the patients in CR after initial surgery (n = 12), EFS was no longer significantly different between the two groups. Patients with residual mass after initial surgery (n = 15) had worse EFS if they did not receive complementary treatment (P <.05). CONCLUSION Although based on a small number of patients, our study showed that (1). no further therapy is a valid therapeutic approach in LPHL patient in CR after initial lymph node resection, and (2). complementary treatment diminishes relapse frequency but has no impact on survival.
Collapse
Affiliation(s)
- B Pellegrino
- Departments of Pediatric Hematology/Oncology of Hôpital, Armand Trousseau, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Donaldson SS. A discourse: the 2002 Wataru W. Sutow lecture. Hodgkin disease in children--perspectives and progress. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:73-81. [PMID: 12461789 DOI: 10.1002/mpo.10219] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
UNLABELLED THE PIONEER: Wataru W. Sutow, 1912-1981, was a remarkable and pivotal leader in pediatric oncology. Early in his medical career, he conducted important clinical and anthropometric studies among Japanese and Marshall Island children exposed to atomic radiation. These studies established standards for childhood growth and development still in use today. Dr. Sutow pioneered the multidisciplinary approach to childhood cancer by combining multidrug chemotherapy protocols with surgery and radiotherapy in the common childhood solid tumors. The textbook "Clinical Pediatric Oncology," of which he was the senior editor, served to define the discipline of pediatric oncology and educate a new era of oncologists in the curative treatment for childhood cancer. THE PAST AND PRESENT: The first edition of "Clinical Pediatric Oncology," published in 1973, demonstrated that only children with early-stage localized Hodgkin disease had a realistic opportunity for cure. Soon the use of combined-modality therapy consisting of low-dose, involved-field radiation plus multi-agent chemotherapy emerged, and made the goal of cure realistic for all patients. This approach is now universal. Today, the 5-year relative survival rate for American children with Hodgkin disease, who are under 14 years of age, is 94%, a dramatic and remarkable achievement. FUTURE Management of children with Hodgkin disease now involves clinical staging and risk-adapted, combined-modality therapy. Clinical and translational research initiatives that hold promise for children with Hodgkin disease in the future include: use of the WHO Classification System combining morphologic and biologic criteria; noninvasive staging procedures with increased sensitivity and specificity; development of a useful prognostic index to define groups for risk-adapted therapy; high-dose therapy with stem cell transplantation; and novel therapies.
Collapse
Affiliation(s)
- Sarah S Donaldson
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California 94305-5302, USA.
| |
Collapse
|
12
|
Schlembach PJ, Wilder RB, Jones D, Ha CS, Fayad LE, Younes A, Hagemeister F, Hess M, Cabanillas F, Cox JD. Radiotherapy alone for lymphocyte-predominant Hodgkin's disease. Cancer J 2002; 8:377-83. [PMID: 12416895 DOI: 10.1097/00130404-200209000-00008] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was to analyze the results with radiotherapy alone in a select group of asymptomatic adults with nonbulky, early-stage lymphocyte-predominant Hodgkin's disease. PATIENTS AND METHODS Between 1963 and 1995, 36 patients with nonbulky stage IA (N = 27) or IIA (N = 9) supradiaphragmatic (N = 27) or subdiaphragmatic (N = 9) lymphocyte-predominant Hodgkin's disease were treated with radiotherapy alone. Eleven of the patients underwent laparotomy. Limited-field radiotherapy involving only one side of the diaphragm and extended-field radiotherapy encompassing both sides of the diaphragm were used in 28 and 8 cases, respectively. Median dose to involved areas was 40.0 Gy given daily in 20 2.0-Gy fractions. Salvage treatmentconsisted of MOPP (mechlorethamine, vincristine, prednisone, procarbazine), CVPP/ABDIC (cyclophosphamide, vinblastine, procarbazine and prednisone/doxorubicin, bleomycin, dacarbazine, lomustine, and prednisone), or ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy and/or involved-field radiotherapy. RESULTS Median follow-up was 8.8 years (range, 3.0-34.4 years). None of the 15 patients with supradiaphragmatic disease who received limited-field radiotherapy to regions that did not include the mediastinal or hilar nodes subsequently experienced relapse there. Only one of 20 patients who received supradiaphragmatic limited-field radiotherapy alone experienced relapse in the paraaortic nodes or spleen. The 5-year relapse-free and overall survival rates for the 20 patients with stage IA lymphocyte-predominant Hodgkin's disease treated with involved-field or regional radiotherapy were 95% and 100%, respectively. There were no cases of severe or life-threatening cardiac toxicity. No solid tumors have been observed in-field in patients treated with limited-field radiotherapy, even though they have been followed up longer than those treated with extended-field radiotherapy (median follow-up, 11.6 vs 5.5 years); two solid tumors have developed in-field in patients who received extended-field radiotherapy. DISCUSSION Involved-field or regional radiotherapy alone may be adequate in stage IA lymphocyte-predominant Hodgkin's disease patients. Longer follow-up will help to more clearly define the risks of cardiac toxicity and solid tumors that result from involved-field or regional radiotherapy, which appear to be low based on follow-up to date.
Collapse
Affiliation(s)
- Pamela J Schlembach
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030-4009, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Wilder RB, Schlembach PJ, Jones D, Chronowski GM, Ha CS, Younes A, Hagemeister FB, Barista I, Cabanillas F, Cox JD. European Organization for Research and Treatment of Cancer and Groupe d'Etude des Lymphomes de l'Adulte very favorable and favorable, lymphocyte-predominant Hodgkin disease. Cancer 2002; 94:1731-8. [PMID: 11920535 DOI: 10.1002/cncr.10404] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lymphocyte-predominant Hodgkin disease (LPHD) is rare and has a natural history different from that of classic Hodgkin disease. There is little information in the literature regarding the role of chemotherapy in patients with early-stage LPHD. The objective of this study was to examine recurrence free survival (RFS), overall survival (OS), and patterns of first recurrence in patients with LPHD who were treated with radiotherapy alone or with chemotherapy followed by radiotherapy. METHODS From 1963 to 1996, 48 consecutive patients ages 16-49 years (median, 28 years) with Ann Arbor Stage I (n = 30 patients) or Stage II (n = 18 patients), very favorable (VF; n = 5 patients) or favorable (F; n = 43 patients) LPHD, according to the European Organization for Research and Treatment of Cancer and Groupe d'Etude des Lymphomes de l'Adulte (EORTC-GELA) criteria, received radiotherapy alone (n = 37 patients) or received chemotherapy followed by radiotherapy (n = 11 patients). The percentages of patients with VF disease (11% vs. 9% in the radiotherapy group vs. the chemotherapy plus radiotherapy group, respectively) or F disease (89% vs. 91%, respectively) within the two treatment groups were similar (P = 1.00). A median of three cycles of chemotherapy with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or with mitoxantrone, vincristine, vinblastine, and prednisone (NOVP) was given initially to six patients and five patients, respectively. A median total radiotherapy dose of 40 grays (Gy) given in daily fractions of 2.0 Gy was delivered to both treatment groups. RESULTS The median follow-up was 9.3 years, and 98% of patients were observed for > or = 3.0 years. RFS was similar for patients who were treated with radiotherapy alone and patients who were treated with chemotherapy followed by radiotherapy (10-year survival rates: 77% and 68%, respectively; P = 0.89). The OS rate also was similar for the two groups (10-year survival rates: 90% and 100%, respectively; P = 0.43). MOPP or NOVP chemotherapy did not reduce the risk of recurrence outside of the radiotherapy fields. CONCLUSIONS MOPP or NOVP chemotherapy did not improve RFS or OS significantly in patients with VF or F LPHD, although the statistical power was limited. Ongoing clinical trials will help to clarify the role of a watch-and-wait strategy or systemic therapy, including anthracycline (epirubicin or doxorubicin), bleomycin, and vinblastine-based chemotherapy or antibody-based approaches, in the treatment of these patients.
Collapse
Affiliation(s)
- Richard B Wilder
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|