1
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Gunawardana J, Law SC, Sabdia MB, Fennell É, Hennessy A, Leahy CI, Murray PG, Bednarska K, Brosda S, Trotman J, Berkahn L, Zaharia A, Birch S, Burgess M, Talaulikar D, Lee JN, Jude E, Hawkes EA, Jain S, Nath K, Snell C, Swain F, Tobin JWD, Keane C, Shanavas M, Blyth E, Steidl C, Savage K, Farinha P, Boyle M, Meissner B, Green MR, Vega F, Gandhi MK. Intra-tumoral and peripheral blood TIGIT and PD-1 as immune biomarkers in nodular lymphocyte predominant Hodgkin lymphoma. Am J Hematol 2024; 99:2096-2107. [PMID: 39152767 PMCID: PMC11469944 DOI: 10.1002/ajh.27459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/28/2024] [Indexed: 08/19/2024]
Abstract
In classical Hodgkin lymphoma (cHL), responsiveness to immune-checkpoint blockade (ICB) is associated with specific tumor microenvironment (TME) and peripheral blood features. The role of ICB in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is not established. To gain insights into its potential in NLPHL, we compared TME and peripheral blood signatures between HLs using an integrative multiomic analysis. A discovery/validation approach in 121 NLPHL and 114 cHL patients highlighted >2-fold enrichment in programmed cell death-1 (PD-1) and T-cell Ig and ITIM domain (TIGIT) gene expression for NLPHL versus cHL. Multiplex imaging showed marked increase in intra-tumoral protein expression of PD-1+ (and/or TIGIT+) CD4+ T-cells and PD-1+CD8+ T-cells in NLPHL compared to cHL. This included T-cells that rosetted with lymphocyte predominant (LP) and Hodgkin Reed-Sternberg (HRS) cells. In NLPHL, intra-tumoral PD-1+CD4+ T-cells frequently expressed TCF-1, a marker of heightened T-cell response to ICB. The peripheral blood signatures between HLs were also distinct, with higher levels of PD-1+TIGIT+ in TH1, TH2, and regulatory CD4+ T-cells in NLPHL versus cHL. Circulating PD-1+CD4+ had high levels of TCF-1. Notably, in both lymphomas, highly expanded populations of clonal TIGIT+PD-1+CD4+ and TIGIT+PD-1+CD8+ T-cells in the blood were also present in the TME, indicating that immune-checkpoint expressing T-cells circulated between intra-tumoral and blood compartments. In in vitro assays, ICB was capable of reducing rosette formation around LP and HRS cells, suggesting that disruption of rosetting may be a mechanism of action of ICB in HL. Overall, results indicate that further evaluation of ICB is warranted in NLPHL.
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Affiliation(s)
- Jay Gunawardana
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Soi C. Law
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Muhammed B. Sabdia
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Éanna Fennell
- School of Medicine, Limerick Digital Cancer Research Centre, Health Research Institute and Bernal Institute, University of Limerick, Limerick, Ireland
| | - Aoife Hennessy
- School of Medicine, Limerick Digital Cancer Research Centre, Health Research Institute and Bernal Institute, University of Limerick, Limerick, Ireland
| | - Ciara I. Leahy
- School of Medicine, Limerick Digital Cancer Research Centre, Health Research Institute and Bernal Institute, University of Limerick, Limerick, Ireland
| | - Paul G. Murray
- School of Medicine, Limerick Digital Cancer Research Centre, Health Research Institute and Bernal Institute, University of Limerick, Limerick, Ireland
- Royal College of Surgeons Ireland, Adliya, Bahrain
| | - Karolina Bednarska
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Sandra Brosda
- Frazer Institute, University of Queensland, Translational Research Institute Brisbane, Australia
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW
| | - Leanne Berkahn
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Andreea Zaharia
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Simone Birch
- Princess Alexandra Hospital, Brisbane, Australia
| | - Melinda Burgess
- School of Medicine, Limerick Digital Cancer Research Centre, Health Research Institute and Bernal Institute, University of Limerick, Limerick, Ireland
- Princess Alexandra Hospital, Brisbane, Australia
| | - Dipti Talaulikar
- Haematology Translational Research Unit, ACT Pathology, Canberra Health Services, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Justina N. Lee
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
| | | | - Eliza A. Hawkes
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Melbourne, Australia
- Transfusion Research Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne Australia
| | - Sanjiv Jain
- Anatomical Pathology Department, The Canberra Hospital, Canberra, Australia
| | - Karthik Nath
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
- Memorial Sloan Kettering Cancer Center, NY, USA
| | - Cameron Snell
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Mater Pathology, Brisbane, Australia
| | - Fiona Swain
- Royal College of Surgeons Ireland, Adliya, Bahrain
- Princess Alexandra Hospital, Brisbane, Australia
| | - Joshua W. D. Tobin
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
| | - Colm Keane
- Frazer Institute, University of Queensland, Translational Research Institute Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
| | - Mohamed Shanavas
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Emily Blyth
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW
- Department of Haematology, Westmead Hospital, Westmead, NSW, Australia
- Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW
| | | | - Kerry Savage
- British Columbia Cancer Agency, Vancouver, Canada
| | | | | | | | | | - Francisco Vega
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maher K. Gandhi
- Blood Cancer Research Group, Mater Research, University of Queensland, Translational Research Institute, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
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2
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Peter E, Ciano-Petersen NL, Do LD, Perrot J, Ngo T, Pluvinage J, Bartley CM, Zorn KC, Miske R, Scharf M, Villagrán-García M, Farina A, Rogemond V, Antoine JC, Tranchant C, Dubois V, DeRisi JL, Pleasure SJ, Wilson MR, Gelfand JM, Traverse-Glehen A, Honnorat J, Desestret V. Anti-RGS8 paraneoplastic cerebellar ataxia is preferentially associated with a particular subtype of Hodgkin's lymphoma. J Neurol 2024; 271:6839-6846. [PMID: 39207522 PMCID: PMC11447075 DOI: 10.1007/s00415-024-12618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 09/04/2024]
Abstract
Ataxia with anti-regulator of G-protein signaling 8 autoantibodies (RGS8-Abs) is an autoimmune disease recently described in four patients. The present study aimed to identify other patients with RGS8-Abs, describe their clinical features, including the link between RGS8-related autoimmune cerebellar ataxia (ACA) and cancer. Patients with RGS8-Abs were identified retrospectively in the biological collections of the French Reference Center for Paraneoplastic Neurological Syndrome and the University of California San Francisco Center for Encephalitis and Meningitis. Clinical data were collected, and cerebrospinal fluid, serum, and tumor pathological samples were retrieved to characterize the autoantibodies and the associated malignancies. Only three patients with RGS8-Abs were identified. All of them presented with a pure cerebellar ataxia of mild to severe course, unresponsive to current immunotherapy regimens for ACA. Two patients presented with a Hodgkin lymphoma of the rare specific subtype called nodular lymphocyte-predominant Hodgkin lymphoma, with very mild extension. Autoantibodies detected in all patients enriched the same epitope on the RGS8 protein, which is an intracellular protein physiologically expressed in Purkinje cells but also ectopically expressed specifically in lymphoma cells of patients with RGS8-related ACA. The present results and those of the four cases previously described suggest that RGS8-Abs define a new paraneoplastic neurological syndrome of extreme rarity found mostly in middle-aged males that associates pure cerebellar ataxia and a particular lymphoma specifically expressing the RGS8 antigen. As in other paraneoplastic ACA with intracellular antigen, the disease course is severe, and patients tend to exhibit a poor response to immune therapy.
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Affiliation(s)
- Elise Peter
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL - CNRS UMR 5284 - INSERM U1314, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Le-Duy Do
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL - CNRS UMR 5284 - INSERM U1314, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jimmy Perrot
- Hospices Civils de Lyon, Service d'Anatomie Pathologique, Centre Hospitalier Lyon Sud, Lyon, France
| | - Thomas Ngo
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - John Pluvinage
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher M Bartley
- Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Ramona Miske
- Unit for Experimental Immunology, Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck, Germany
| | - Madeleine Scharf
- Unit for Experimental Immunology, Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck, Germany
| | - Macarena Villagrán-García
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL - CNRS UMR 5284 - INSERM U1314, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Antonio Farina
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL - CNRS UMR 5284 - INSERM U1314, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Véronique Rogemond
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL - CNRS UMR 5284 - INSERM U1314, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Christophe Antoine
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Université Jean Monnet, Saint-Etienne, France
- Département de Neurologie, Centre Hospitalier Universitaire de Saint Etienne, Saint-Etienne, France
| | - Christine Tranchant
- Service de Neurologie, Hôpital de Hautepierre, Strasbourg, France
- Faculté de Médecine, Fédération de Médecine Translationnelle, Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
| | - Valérie Dubois
- Laboratoire d'étude du HLA, Etablissement Français du Sang Auvergne-Rhône-Alpes, Lyon, France
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub SF, San Francisco, CA, USA
| | - Samuel J Pleasure
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL - CNRS UMR 5284 - INSERM U1314, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Virginie Desestret
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.
- MeLiS - UCBL - CNRS UMR 5284 - INSERM U1314, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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3
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Sereda S, Shankar A, Weber L, Ramsay AD, Hall GW, Hayward J, Wallace WHB, Landman-Parker J, Braeuninger A, Hasenclever D, Schneider A, Mauz-Koerholz C, Koerholz D, Gattenloehner S. Digital pathology in pediatric nodular lymphocyte-predominant Hodgkin lymphoma: correlation with treatment response. Blood Adv 2023; 7:6285-6289. [PMID: 37611165 PMCID: PMC10589766 DOI: 10.1182/bloodadvances.2023010652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Sergej Sereda
- Department of Pathology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Ananth Shankar
- Children and Young People’s Cancer Services, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Luise Weber
- Department of Pathology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Alan D. Ramsay
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Georgina W. Hall
- Paediatric and Adolescent Haematology & Oncology Unit, Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Janis Hayward
- School of Cancer Sciences, Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | | | - Judith Landman-Parker
- Sorbonne University, Assistance Publique–Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - Andreas Braeuninger
- Department of Pathology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Astrid Schneider
- Pediatric Hematology and Oncology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Christine Mauz-Koerholz
- Pediatric Hematology and Oncology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
- Medical Faculty of the Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Dieter Koerholz
- Pediatric Hematology and Oncology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Stefan Gattenloehner
- Department of Pathology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
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4
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Freitas BD, Salgadinho Machado A, Lagarto M, Araújo I, Fonseca C. Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Rare Lymphoma with Isolated Hepatic Presentation. Eur J Case Rep Intern Med 2023; 10:004061. [PMID: 37920229 PMCID: PMC10619525 DOI: 10.12890/2023_004061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 11/04/2023] Open
Abstract
Primary hepatic lymphoma (PHL) is extremely rare, accounting for less than 1% of all lymphomas, and is limited to the liver without extrahepatic involvement. A 30-year-old male was admitted in the Emergency Department complaining of weakness, fever, night sweats, significant weight loss, discrete ring alopecia, hepatomegaly, right axillary adenopathy and oedema of both legs. Laboratory evaluation showed normocytic normochromic anaemia, thrombocytosis, hyperbilirubinemia, cholestasis and increased international normalised ratio (INR). A computed tomography (CT) scan found an enlarged liver with a heterogeneous structure and moderate ascites. After admission in our ward further investigation revealed increased sedimentation velocity, ferritin and serum lactate dehydrogenase. A hepatic biopsy was performed which confirmed the diagnosis as a nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). The patient was transferred to a haematological ward and underwent chemotherapy with six cycles of R-CHOP. He is in complete remission after a year and half since the beginning of treatment. NLPHL, a very rare lymphoma, is more common in men between the third and fifth decades of life. Usually, the symptoms are very unspecific; a few patients have B symptoms at admission. This kind of presentation is also common in infectious, metabolic and autoimmune diseases, which were excluded in this case. Due to technical issues the final diagnosis was only possible due to the liver biopsy. Treatment with standard Hodgkin lymphoma protocols leads to complete remission in more that 95% of patients with NLPHL. LEARNING POINTS Differential diagnosis of fever, especially in young patients, is very complex and complete investigation takes time, which can delay the diagnosis of malignancies such as primary hepatic lymphoma (PHL).PHL is very rare, and overlapping symptoms with other liver diseases can make the diagnosis very challenging.When the suspicion of PHL is very high, only the hepatic biopsy can lead to the correct diagnosis because the disease has no extrahepatic involvement.
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Affiliation(s)
- Bruno David Freitas
- Serviço de Medicina Interna, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Andreia Salgadinho Machado
- Serviço de Medicina Interna, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Margarida Lagarto
- Serviço de Medicina Interna, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Inês Araújo
- Serviço de Medicina Interna, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Candida Fonseca
- Serviço de Medicina Interna, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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5
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Eichenauer DA, Bühnen I, Baues C, Kobe C, Kaul H, Greil R, Moccia A, Zijlstra JM, Hertenstein B, Topp MS, Just M, von Tresckow B, Eich HT, Fuchs M, Dietlein M, Hartmann S, Engert A, Borchmann P. Interim PET-guided treatment for early-stage NLPHL: a subgroup analysis of the randomized GHSG HD16 and HD17 studies. Blood 2023; 142:553-560. [PMID: 37257195 DOI: 10.1182/blood.2023019939] [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: 01/31/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
The optimal first-line treatment for nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) diagnosed in early stages is largely undefined. We, therefore, analyzed 100 NLPHL patients treated in the randomized HD16 (early-stage favorable; n = 85) and HD17 (early-stage unfavorable; n = 15) studies. These studies investigated the omission of consolidation radiotherapy (RT) in patients with a negative interim positron emission tomography (iPET) (ie, Deauville score <3) after chemotherapy (HD16: 2× doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]; HD17: 2× escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone [BEACOPP] plus 2× ABVD). Patients with NLPHL treated in the HD16 and HD17 studies had 5-year progression-free survival (PFS) rates of 90.3% and 92.9%, respectively. Thus, the 5-year PFS did not differ significantly from that of patients with classical Hodgkin lymphoma treated within the same studies (HD16: P = .88; HD17: P = .50). Patients with early-stage favorable NLPHL who had a negative iPET after 2× ABVD and did not undergo consolidation RT tended to have a worse 5-year PFS than patients with a negative iPET who received consolidation RT (83% vs 100%; P = .05). There were 10 cases of NLPHL recurrence. However, no NLPHL patient died during follow-up. Hence, the 5-year overall survival rate was 100%. Taken together, contemporary Hodgkin lymphoma-directed treatment approaches result in excellent outcomes for patients with newly diagnosed early-stage NLPHL and, thus, represent valid treatment options. In early-stage favorable NLPHL, consolidation RT appears necessary after 2× ABVD to achieve the optimal disease control irrespective of the iPET result.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Ina Bühnen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Christian Baues
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Helen Kaul
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Richard Greil
- Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austrian Group for Medical Tumor Therapy, Paracelsus Medical University, Salzburg, Austria
| | - Alden Moccia
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Joseé M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bernd Hertenstein
- Department of Internal Medicine I, Klinikum Bremen-Mitte, Bremen, Germany
| | - Max S Topp
- Second Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, German Cancer Consortium (DKTK partner site Essen), Essen, Germany
| | - Hans-Theodor Eich
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Radiotherapy, University Hospital Münster, Münster, Germany
| | - Michael Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Markus Dietlein
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas Engert
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
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6
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Vuolio T, Kuittinen O, Väyrynen JP, Teppo HR, Prusila REI, Rämet M, Kuitunen H, Paloneva T, Kuusisto MEL. R-bendamustine in the treatment of nodular lymphocyte predominant Hodgkin lymphoma-An extended follow-up. Br J Haematol 2023; 202:e24-e26. [PMID: 37282360 DOI: 10.1111/bjh.18896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Tero Vuolio
- University of Oulu and Oulu University Hospital, Oulu, Finland
- Faculty of Health Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Outi Kuittinen
- Faculty of Health Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
- Kuopio University Hospital Cancer Center, Kuopio, Finland
| | - Juha P Väyrynen
- Department of Pathology, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Translational Medicine Research Unit, University of Oulu, Oulu, Finland
| | - Hanna-Riikka Teppo
- Department of Pathology, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Translational Medicine Research Unit, University of Oulu, Oulu, Finland
| | - Roosa E I Prusila
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Timo Paloneva
- Central Ostrobothnian Central Hospital, Kokkola, Finland
| | - Milla E L Kuusisto
- University of Oulu and Oulu University Hospital, Oulu, Finland
- Faculty of Health Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Translational Medicine Research Unit, University of Oulu, Oulu, Finland
- Länsi-Pohja Central Hospital, Kemi, Finland
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7
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Eichenauer DA, Hartmann S. Nodular lymphocyte-predominant Hodgkin lymphoma: current management strategies and evolving approaches to individualize treatment. Expert Rev Hematol 2023; 16:607-615. [PMID: 37337881 DOI: 10.1080/17474086.2023.2226859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma entity accounting for roughly 5% of all Hodgkin lymphoma (HL) cases. In contrast to classical HL, the malignant cells in NLPHL are positive for CD20 but lack CD30. The disease usually has an indolent clinical course resulting in high long-term survival rates. AREAS COVERED In this review, treatment options for NLPHL are summarized and factors that may help to individualize treatment are discussed. EXPERT OPINION Stage IA NLPHL without clinical risk factors should be treated with limited-field radiotherapy alone. In all other stages, NLPHL patients have excellent outcomes after standard HL approaches. The question of whether the addition of an anti-CD20 antibody to standard HL chemotherapy protocols or the use of approaches typically applied in B-cell non-Hodgkin lymphoma improve treatment results is unanswered until now. Different management strategies ranging from low-intensity treatment to high-dose chemotherapy and autologous stem cell transplantation have demonstrated activity in relapsed NLPHL. Second-line treatment is thus chosen individually. The major aim of NLPHL research is to spare toxicity and reduce the risk for treatment-related adverse events in low-risk patients while treating higher-risk patients with appropriate intensity. To this end, novel tools to guide treatment are required.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt Am Main, Germany
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8
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Eichenauer DA, Fuchs M. Treatment of Nodular Lymphocyte-Predominant Hodgkin Lymphoma: Where Do We Stand? Where Do We Go? Cancers (Basel) 2023; 15:3310. [PMID: 37444420 DOI: 10.3390/cancers15133310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare B cell-derived lymphoma entity accounting for ≈5% of all Hodgkin lymphoma (HL) cases. In recent decades, patients with newly diagnosed NLPHL have usually been treated very similarly to classical HL (cHL). The 10-year overall survival rates with HL-directed approaches are in excess of 90%. However, pathological and clinical characteristics of NLPHL resemble indolent B-cell non-Hodgkin lymphoma (B-NHL) in some aspects. Thus, nodular lymphocyte-predominant B-cell lymphoma has been proposed as an alternative name, and the use of B-NHL-directed treatment strategies has become more common in NLPHL despite limited data. Given the often indolent clinical course of NLPHL, even in the case of relapse, the majority of patients with disease recurrence do not require high-dose chemotherapy and autologous stem cell transplantation but are treated sufficiently with low-intensity approaches such as single-agent anti-CD20 antibody treatment. The establishment of novel prognostic scores for NLPHL patients may optimize risk group and treatment allocation in newly diagnosed and relapsed disease.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, D-50937 Cologne, Germany
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, D-50937 Cologne, Germany
| | - Michael Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, D-50937 Cologne, Germany
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, D-50937 Cologne, Germany
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9
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Juarez A, Parza K, Galindo L, Faris M. The Importance of Excisional Biopsy in Nodular Lymphocyte-Predominant Hodgkin's Lymphoma. Cureus 2023; 15:e40225. [PMID: 37435260 PMCID: PMC10332487 DOI: 10.7759/cureus.40225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
Hodgkin's lymphoma (HL) is a malignancy that is typically B-cell in origin. HL can be further classified into classical HL and nodular lymphocyte-predominant HL (NLPHL). NLPHL is a rare lymphoma. It commonly presents locally with palpable firm lymphadenopathy or mediastinal mass seen on chest imaging. Some patients may have B symptoms (fever, night sweats, and unintentional weight loss), splenomegaly, and hepatomegaly. We describe a case of NLPHL in a 32-year-old male with classical findings of this rare class of HL.
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Affiliation(s)
- Angel Juarez
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Kevin Parza
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Lidice Galindo
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Mohamed Faris
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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10
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Gotti M, Sciarra R, Pulsoni A, Merli F, Luminari S, Zerbi C, Trentin L, Re A, Rusconi C, Viviani S, Rossi A, Cocito F, Botto B, Meli E, Pinto A, Dogliotti I, Gini G, Puccini B, Ricci F, Nassi L, Fabbri A, Liberati AM, Merli M, Filippi AR, Bonfichi M, Zoboli V, Tartaglia G, Annechini G, D’Elia GM, Del Giudice I, Alvarez I, Visentin A, Pravato S, Dalceggio D, Pagani C, Ferrari S, Cristinelli C, Lazic T, Ferretti VV, Ricardi U, Arcaini L. Role of Rituximab Addition to First-line Chemotherapy Regimens in Nodular Lymphocyte-predominant Hodgkin Lymphoma: A Study by Fondazione Italiana Linfomi. Hemasphere 2023; 7:e837. [PMID: 37034003 PMCID: PMC10079338 DOI: 10.1097/hs9.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/29/2022] [Indexed: 04/08/2023] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity whose neoplastic cells retain a B-cell phenotype with expression of CD20. Radiotherapy is recommended for favorable stage IA disease while for other stages guidelines suggest therapeutic strategies similar to those used for classic HL. The role of rituximab, although quite widespread, is not completely elucidated. We retrospectively analyzed baseline characteristics of 308 consecutive patients with NLPHL diagnosed in 19 Italian centers from 2000 to 2018. With a median follow-up of 8.4 years (interquartile range: 4.5–12.4) for treated patients, median overall survival (OS) was not reached and estimated 5-year OS was 97.8% and 5-year progression-free survival (PFS) was 84.5%. Five-year cumulative incidence of histological transformation was 1.4%, 95% confidence interval (CI), 0.5%-3.8%. After adjusting for lymphocyte count, splenic involvement, bulky disease and B symptoms (fever, drenching night sweats, unintentional loss >10% of body weight within the preceding 6 months), patients with stage II or more showed superior PFS with immunochemotherapy in comparison to chemotherapy alone (hazard ratio = 0.4, 95% CI, 0.2-0.8; P = 0.015). Our data suggest an advantage of the use of rituximab combined with chemotherapy ± radiotherapy in the treatment of stage II–III–IV NLPHL.
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Affiliation(s)
- Manuel Gotti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Sciarra
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Italy
| | - Alessandro Pulsoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Francesco Merli
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Italy
| | - Stefano Luminari
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
| | - Caterina Zerbi
- Department of Molecular Medicine, University of Pavia, Italy
| | - Livio Trentin
- Hematology Unit, Department of Medicine - DIMED, University of Padova, Italy
| | - Alessandro Re
- Division of Hematology, Spedali Civili, Brescia, Italy
| | - Chiara Rusconi
- Division of Hematology and Blood Marrow Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Simonetta Viviani
- Division of Hematology and Blood Marrow Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Rossi
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federica Cocito
- Division of Hematology, ASST Monza, Ospedale S. Gerardo, Monza, Italy
| | - Barbara Botto
- Division of Hematology, Azienda Ospedale Città della Salute e della Scienza, Torino, Italy
| | - Erika Meli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Antonello Pinto
- Hematology-Oncology and Stem-Cell Transplantation Unit, Department of Hematology and Developmental Therapeutics, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy
| | - Irene Dogliotti
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Italy
| | - Guido Gini
- Department of Hematology, Ospedali Riuniti, Ancona, Italy
| | | | - Francesca Ricci
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Luca Nassi
- Hematology, Department of Translational Medicine, AOU Maggiore della Carità and University of Eastern Piedmont, Novara, Italy
| | - Alberto Fabbri
- Division of Hematology, Azienda Ospedaliero- Universitaria Senese, Siena, Italy
| | - Anna Marina Liberati
- Division of Hematology, Azienda Ospedalaliera S. Maria di terni – Università degli Studi di Perugia, Italy
| | - Michele Merli
- Division of Hematology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Maurizio Bonfichi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Zoboli
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Germana Tartaglia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Gianna Maria D’Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Isabel Alvarez
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Italy
| | - Andrea Visentin
- Hematology Unit, Department of Medicine - DIMED, University of Padova, Italy
| | - Stefano Pravato
- Hematology Unit, Department of Medicine - DIMED, University of Padova, Italy
| | | | - Chiara Pagani
- Division of Hematology, Spedali Civili, Brescia, Italy
| | - Silvia Ferrari
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Tanja Lazic
- Department of Molecular Medicine, University of Pavia, Italy
| | - Virginia Valeria Ferretti
- Service of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Umberto Ricardi
- Radiation Oncology, Department of Oncology, University of Turin, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Italy
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11
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Immunohistochemical Expression of B Cell Transcription Factors in Hodgkin’s Lymphoma and Their Use in Differential Diagnosis. JOURNAL OF CONTEMPORARY MEDICINE 2023. [DOI: 10.16899/jcm.1224116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Aim: Classical Hodgkin lymphoma is common, it is one of the lymphomas whose differential diagnosis can be difficult. It is thought that Hodgkin cell may originate from the germinal center. Our aim in this study was to determine the germinal center transformation markers OCT-2, BOB.1, BCL-6, PAX-5, CD20 and MUM-1 in Classic Hodgkin Lymphoma (CHL), Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) and Diffuse Large B-cell Lymphoma (DLBCL) to evaluate the expressions of by immunohistochemical method and chromogenic in-situ hybridization (ISH) of EBV early RNAs (EBER).
Material and methods: 49 biopsies diagnosed with Hodgkin lymphoma (HL), 5 with NLPHL and 19 with DLBCL were evaluated for CD30, PAX-5, OCT-2, BOB.1, MUM-1, BCL-6, and CD20, and EBER positivity. SPSS 18 was used for statistical analysis.
Results: 73 lymphoma cases were included in the study, 61.6% males and 38.4% females. The median age of patients was 50 years. CHL (67.1%) was the most common lymphoma type, and mixed cellular Hodgkin lymphoma (MSHL) was the most common subtype. There was a statistically significant difference in CD30, OCT-2, BOB.1, MUM-1, PAX-5, CD20, BCL-6, EBER expression between CHL and DLBCL cases (p
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12
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Lo AC, Major A, Super L, Appel B, Shankar A, Constine LS, Marks LJ, Kelly KM, Metzger ML, Buhtoiarov IN, Mauz-Körholz C, Costa ARS, Binkley MS, Flerlage J. Practice patterns for the management of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL): an international survey by the Global NLPHL One Working Group (GLOW). Leuk Lymphoma 2022; 63:1997-2000. [PMID: 35357263 DOI: 10.1080/10428194.2022.2053533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Andrea C Lo
- Radiation Oncology, BC Cancer, Vancouver, Canada
- Surgery, University of British Columbia, Vancouver, Canada
| | - Ajay Major
- The University of Chicago Medical Center, Chicago, IL, USA
| | - Leanne Super
- Children's Cancer Centre, Monash Children's Hospital, Melbourne, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
- Pediatrics, Monash University, Melbourne, Australia
| | - Burton Appel
- Pediatric Hematology-Oncology, Joseph M. Sanzari Children's Hospital, Hackensack, NJ, USA
| | - Ananth Shankar
- Child and Young People's Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Louis S Constine
- Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
- Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Lianna J Marks
- Pediatric Hematology, Oncology, and Stem Cell Transplantation, Stanford University School of Medicine, Stanford, CA, USA
| | - Kara M Kelly
- Pediatric Hematology/Oncology, Roswell Park Comprehensive Cancer Center, University at Buffalo, Buffalo, NY, USA
| | - Monika L Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ilia N Buhtoiarov
- Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Christine Mauz-Körholz
- Pediatric Hematology and Oncology, Justus-Liebig-University of Giessen, Gießen, Germany
- Medical Faculty of the Martin-Luther University of Halle-Wittenberg, Halle, Germany
| | - Ana Rosa S Costa
- HematoOnco Pediatra, Hospital de Câncer Infantojuvenil de Barretos, Barretos, Brazil
| | - Michael S Binkley
- Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jamie Flerlage
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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13
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Hartmann S, Soltani AS, Bankov K, Bein J, Hansmann ML, Rosenwald A, Bernd HW, Feller A, Ott G, Möller P, Stein H, Klapper W, Borchmann P, Engert A, Eichenauer DA. Tumour cell characteristics and microenvironment composition correspond to clinical presentation in newly diagnosed nodular lymphocyte-predominant Hodgkin lymphoma. Br J Haematol 2022; 199:382-391. [PMID: 35880396 DOI: 10.1111/bjh.18376] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 12/21/2022]
Abstract
Different studies have characterized the microenvironment and its prognostic impact in classic Hodgkin lymphoma whereas such analyses are pending for nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). We thus investigated characteristics of tumour cells and microenvironment in NLPHL and evaluated possible correlations with the clinical presentation. Lymph node samples from 152 NLPHL patients who had first-line treatment within the randomized German Hodgkin Study Group HD16-HD18 trials were available and analysed with regard to IgD status and nuclear size of the tumour cells as well as presence of PD1-positive follicular T helper cells and CD163-positive macrophages in the microenvironment. While large tumour cell nuclei and high numbers of PD1-positive follicular T helper cells in the microenvironment were more common in patients presenting with early/intermediate stages than in patients with advanced-stage disease (p < 0.0001, unpaired t-test; p = 0.0022, Mann-Whitney test), no differences between risk groups were observed in terms of the IgD status of the tumour cells and the content of CD163-positive macrophages in the microenvironment. PD1-positive follicular T helper cells were present in both cases with typical and variant growth patterns and rosetting around the tumour cells was observed in 96% of patients, indicating an important role of PD1-positive follicular T helper cells in NLPHL.
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Affiliation(s)
- Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ahmad Sajad Soltani
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Katrin Bankov
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Julia Bein
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Martin-Leo Hansmann
- Frankfurt Institute for Advanced Studies, Frankfurt am Main, Germany.,Institute of General Pharmacology and Toxicology, Goethe University Frankfurt, Frankfurt am Main, Germany.,Institute of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg and Comprehensive Cancer Center (CCC) Mainfranken, Würzburg, Germany
| | | | | | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Peter Möller
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
| | | | - Wolfram Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Andreas Engert
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
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14
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Samara Y, Mei M. Autologous Stem Cell Transplantation in Hodgkin Lymphoma-Latest Advances in the Era of Novel Therapies. Cancers (Basel) 2022; 14:1738. [PMID: 35406509 PMCID: PMC8996995 DOI: 10.3390/cancers14071738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Standard treatment for relapsed and/or refractory (r/r) Hodgkin lymphoma (HL) consists of salvage therapy, historically consisting of multiagent cytotoxic chemotherapy, followed by autologous stem cell transplantation (autoHCT) in responding patients. With this approach, most patients can proceed to autoHCT, of whom approximately half are cured. However, the introduction of the novel agents brentuximab vedotin (BV) and the checkpoint inhibitors (CPI) nivolumab and pembrolizumab has changed the decision making and peri-transplant decision making, as early incorporation of one or more of these agents can reduce or even eliminate the need for cytotoxic chemotherapy prior to autoHCT. Furthermore, post-autoHCT maintenance therapy with BV has also been shown to decrease relapse in high-risk rel/ref HL patients. In this review, we survey the current data regarding autoHCT in HL with a focus on pre-autoHCT salvage as well as maintenance strategies, and we also talk about the emerging data challenging the long-held dogma of chemosensitivity being a requirement for successful autoHCT.
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Affiliation(s)
- Yazeed Samara
- Division of Hematology and Medical Oncology, Harbor-UCLA Medical Center, Torrance, CA 90502, USA;
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA 91010, USA
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15
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Eichenauer DA, Bühnen I, Plütschow A, Kobe C, Dietlein M, Wendtner CM, Thorspecken S, Topp MS, Mauser M, von Tresckow B, Fuchs M, Borchmann P, Engert A. Phase II study of fixed-duration single-agent ibrutinib in relapsed nodular lymphocyte-predominant Hodgkin lymphoma: A report from the German Hodgkin Study Group. Hematol Oncol 2022; 40:801-804. [PMID: 35313381 DOI: 10.1002/hon.2986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Ina Bühnen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Annette Plütschow
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Carsten Kobe
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany.,Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Markus Dietlein
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany.,Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich Clinic Schwabing, Munich, Germany
| | - Sven Thorspecken
- Department of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich Clinic Schwabing, Munich, Germany
| | - Max S Topp
- Second Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Mareike Mauser
- Second Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany.,Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Andreas Engert
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
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16
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Eichenauer DA, Engert A. Current treatment options for nodular lymphocyte-predominant Hodgkin lymphoma. Curr Opin Oncol 2021; 33:395-399. [PMID: 34224482 DOI: 10.1097/cco.0000000000000774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare B cell-derived malignancy. This review aims at providing an overview of recent developments in the management of NLPHL. RECENT FINDINGS Patients with stage IA NLPHL without risk factors have excellent outcomes. The 8-year progression-free survival (PFS) is roughly 90% and the 8-year overall survival (OS) close to 100% after limited-field radiotherapy (RT) alone. Individuals presenting with early stages other than stage IA without risk factors and intermediate stages have 10-year PFS rates in excess of 70% and 10-year OS rates exceeding 90% when treated with 2 and 4 cycles of ABVD, respectively, followed by consolidation RT. In advanced NLPHL, different protocols such as BEACOPP, ABVD, and R-CHOP have been evaluated retrospectively. However, the optimal approach is undefined. Patients with relapsed NLPHL mostly receive single-agent anti-CD20 antibody treatment or conventional chemotherapy. High-dose chemotherapy and autologous stem cell transplantation are restricted to high-risk patients. NLPHL recurrence is salvaged successfully in the majority of cases. SUMMARY Patients with NLPHL have a very good prognosis. Treatment differs from classical Hodgkin lymphoma in some situations.
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Affiliation(s)
- Dennis A Eichenauer
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Andreas Engert
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
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17
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Eichenauer DA, Bühnen I, Kreissl S, Goergen H, Fuchs M, von Tresckow B, Rosenwald A, Klapper W, Hansmann ML, Möller P, Bernd HW, Feller AC, Engert A, Borchmann P, Hartmann S. Histopathological growth patterns in patients with advanced nodular lymphocyte-predominant Hodgkin lymphoma treated within the randomized HD18 study: a report from the German Hodgkin Study Group. Br J Haematol 2021; 196:99-104. [PMID: 34396513 DOI: 10.1111/bjh.17770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
We retrospectively investigated histopathological growth patterns in individuals with advanced nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) treated within the randomized HD18 study. In all, 35/60 patients (58%) presented with atypical growth patterns. Patients with atypical growth patterns more often had stage IV disease (P = 0·0354) and splenic involvement (P = 0·0048) than patients with typical growth patterns; a positive positron emission tomography after two cycles of chemotherapy (PET-2) tended to be more common (P = 0·1078). Five-year progression-free survival [hazard ratio (HR) = 0·86; 95% confidence interval (CI) = 0·49-1·47] and overall survival (HR = 0·85; 95% CI = 0·49-1·51) did not differ between the groups after study treatment with PET-2-guided escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). Thus, advanced NLPHL is often associated with atypical growth patterns but their prognostic impact is compensated by PET-2-guided escalated BEACOPP.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Ina Bühnen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Stefanie Kreissl
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Helen Goergen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Michael Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany.,Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg and Comprehensive Cancer Center (CCC) Mainfranken, Würzburg, Germany
| | - Wolfram Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Martin-Leo Hansmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Peter Möller
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
| | | | | | - Andreas Engert
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
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18
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Menke JR, Spinner MA, Natkunam Y, Warnke RA, Advani RH, Gratzinger DA. CD20-Negative Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A 20-Year Consecutive Case Series From a Tertiary Cancer Center. Arch Pathol Lab Med 2021; 145:753-758. [PMID: 32991677 DOI: 10.5858/arpa.2020-0135-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare, indolent Hodgkin lymphoma subtype with distinct clinicopathologic features and treatment paradigms. The neoplastic lymphocyte-predominant cells typically express bright CD20 and other B-cell antigens, which distinguishes them from Hodgkin/Reed-Sternberg cells of lymphocyte-rich classic Hodgkin lymphoma. OBJECTIVE.— To characterize the clinicopathologic features of CD20-negative NLPHL at a single institution. DESIGN.— A retrospective search for CD20-negative NLPHL in our pathology archives and medical records was conducted. RESULTS.— Of 486 NLPHL patients identified with CD20 available for review, 14 (2.8%) had LP cells with absent CD20 expression. Patients with prior rituximab administration (n = 7) and insufficient clinical history (n = 1) were excluded, leaving 6 patients with rituximab-naïve, CD20-negative NLPHL. A broad immunohistochemical panel showed the LP cells in all cases expressed B-cell antigens, particularly Oct-2, although PAX5 and CD79a were frequently also dim. CD30, CD15, and Epstein-Barr virus-encoded small RNAs were negative in all evaluated cases. Two patients had high-risk variant immunoarchitectural pattern D. One patient had extranodal disease, involving the spleen and bone, and was suspected to have large cell transformation. Standard NLPHL therapy was given, including local radiation and/or chemotherapy. Of 5 patients with available follow-up, 4 are alive in complete remission after therapy, and 1 is alive with relapsed disease. CONCLUSIONS.— NLPHL can lack CD20 de novo without prior rituximab therapy. In such cases, extensive immunophenotyping helps distinguish NLPHL from lymphocyte-rich classic Hodgkin lymphoma, which differ in clinical behavior and therapy. In our series, CD20-negative NLPHL showed both classic and variant histologic patterns and the expected range of clinical behavior seen in NLPHL, including 1 case with suspected large cell transformation.
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Affiliation(s)
- Joshua R Menke
- From the Department of Pathology (Menke, Natkunam, Warnke, Gratzinger), at Stanford University Medical Center, Stanford, California
| | - Michael A Spinner
- Division of Oncology, Department of Medicine (Spinner, Advani), at Stanford University Medical Center, Stanford, California
| | - Yasodha Natkunam
- From the Department of Pathology (Menke, Natkunam, Warnke, Gratzinger), at Stanford University Medical Center, Stanford, California
| | - Roger A Warnke
- From the Department of Pathology (Menke, Natkunam, Warnke, Gratzinger), at Stanford University Medical Center, Stanford, California
| | - Ranjana H Advani
- Division of Oncology, Department of Medicine (Spinner, Advani), at Stanford University Medical Center, Stanford, California
| | - Dita A Gratzinger
- From the Department of Pathology (Menke, Natkunam, Warnke, Gratzinger), at Stanford University Medical Center, Stanford, California
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19
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Pitfalls in the Diagnosis of Nodular Lymphocyte Predominant Hodgkin Lymphoma: Variant Patterns, Borderlines and Mimics. Cancers (Basel) 2021; 13:cancers13123021. [PMID: 34208705 PMCID: PMC8234802 DOI: 10.3390/cancers13123021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma containing infrequent tumor cells (LP cells) in a background of non-neoplastic cells. Some cases of NLPHL can recur or progress to a more aggressive lymphoma, such as diffuse large B-cell lymphoma. Awareness of the different appearances of NLPHL and its overlap with other lymphomas are important for the appropriate diagnosis, classification and research. This article discusses the conceptual framework and guidelines for the diagnosis of NLPHL, and how NLPHL can be best separated from its mimics. Emerging data in the field point to genetic changes in LP cells that are shaped by immune mechanisms. In addition, non-neoplastic cells in the background of LP cells also appear to play an important role. Further investigation is necessary to fully understand the biology of NLPHL and personalize cancer care for patients affected by this lymphoma. Abstract Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) represents approximately 5% of Hodgkin lymphoma and typically affects children and young adults. Although the overall prognosis is favorable, variant growth patterns in NLPHL correlate with disease recurrence and progression to T-cell/histiocyte-rich large B-cell lymphoma or frank diffuse large B-cell lymphoma (DLBCL). The diagnostic boundary between NLPHL and DLBCL can be difficult to discern, especially in the presence of variant histologies. Both diagnoses are established using morphology and immunophenotype and share similarities, including the infrequent large tumor B-cells and the lymphocyte and histiocyte-rich microenvironment. NLPHL also shows overlap with other lymphomas, particularly, classic Hodgkin lymphoma and T-cell lymphomas. Similarly, there is overlap with non-neoplastic conditions, such as the progressive transformation of germinal centers. Given the significant clinical differences among these entities, it is imperative that NLPHL and its variants are carefully separated from other lymphomas and their mimics. In this article, the characteristic features of NLPHL and its diagnostic boundaries and pitfalls are discussed. The current understanding of genetic features and immune microenvironment will be addressed, such that a framework to better understand biological behavior and customize patient care is provided.
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20
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Momotow J, Borchmann S, Eichenauer DA, Engert A, Sasse S. Hodgkin Lymphoma-Review on Pathogenesis, Diagnosis, Current and Future Treatment Approaches for Adult Patients. J Clin Med 2021; 10:1125. [PMID: 33800409 PMCID: PMC7962816 DOI: 10.3390/jcm10051125] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 01/07/2023] Open
Abstract
Hodgkin lymphoma (HL) is a rare malignancy accounting for roughly 15% of all lymphomas and mostly affecting young patients. A second peak is seen in patients above 60 years of age. The history of HL treatment represents a remarkable success story in which HL has turned from an incurable disease to a neoplasm with an excellent prognosis. First-line treatment with stage-adapted treatment consisting of chemotherapy and/or radiotherapy results in cure rates of approximately 80%. Second-line treatment mostly consists of intensive salvage chemotherapy followed by high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). Novel approaches such as antibody drug conjugates and immunomodulatory drugs have shown impressive results in clinical trials in refractory and relapsed HL and are now increasingly implemented in earlier treatment lines. This review gives a comprehensive overview on HL addressing epidemiology, pathophysiology and current treatment options as well as recent developments and perspectives.
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Affiliation(s)
- Jesko Momotow
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Sven Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Dennis A. Eichenauer
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Stephanie Sasse
- Department IV of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Aachen, University of Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
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21
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Eichenauer DA, Kreissl S, Bühnen I, Baues C, Kobe C, van Heek L, Goergen H, Fuchs M, Hartmann S, von Tresckow B, Engert A, Borchmann P. PET-2-guided escalated BEACOPP for advanced nodular lymphocyte-predominant Hodgkin lymphoma: a subgroup analysis of the randomized German Hodgkin Study Group HD18 study. Ann Oncol 2021; 32:807-810. [PMID: 33667668 DOI: 10.1016/j.annonc.2021.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- D A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany.
| | - S Kreissl
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - I Bühnen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - C Baues
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - C Kobe
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - L van Heek
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - H Goergen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - M Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - S Hartmann
- Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - B von Tresckow
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - A Engert
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - P Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
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22
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Núñez-García B, Rodríguez-Pertierra M, Sequero S, Carvajal LG, Ruano-Ravina A, Aguiar D, Gumá J, Blanco CQ, García Arroyo FR, Garitaonaindia Y, Provencio Z, Calvo V, González-San Segundo C, Provencio M. Long-term follow-up of patients with nodular lymphocyte predominant Hodgkin lymphoma: A report from the Spanish Lymphoma Oncology Group. Hematol Oncol 2021; 39:506-512. [PMID: 33528063 DOI: 10.1002/hon.2835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/21/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022]
Abstract
Nodular lymphocytic predominance Hodgkin lymphoma (NLPHL) is a very uncommon subtype of Hodgkin lymphoma (HL), representing approximately 5% of all HL cases, with an incidence of 0.3/100,000 cases per year and with unique characteristics which distinguish it from classic Hodgkin lymphoma. Given its low frequency, there is a lack of prospective randomized studies to inform practice, the accumulated experience of academic groups being the main source of relevant information for the management of these patients. Eighty-five patients recruited by the Spanish Lymphoma Group (GOTEL) from 12 different hospitals were retrospectively analyzed to describe their sociodemographic and clinical characteristics. The median follow-up was 16 years, with a 10-year overall survive of 92.9% and 81.2% at 20 years. Five patients developed a second malignancy. No transformation to a more aggressive lymphoma was detected. A total of 31% tumor relapses was found: 77% in a single location; most of them at a supra-diaphragmatic level. Patients received different first-line treatments, and progression was observed in 3/4 (75%) of the patients who did not receive any type of treatment, 6/23 (26%) who received both chemotherapy (CH) and radiotherapy (RT), 12/43 (27%) who received RT and 7/15 (47%) that received only CH treatment. The mean time to relapse was 3 years and 47% presented relapses beyond 5 years (higher probability in stage IV p < 0.001). This is one of the longest follow-up series of NLPHL published, confirming its excellent prognosis, and that treatments may be adapted to reduce toxicity. Causes of death in these patients are varied, and the minority due to a primary malignancy relapses.
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Affiliation(s)
| | | | - Silvia Sequero
- Department of Medical Oncology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Laura G Carvajal
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Alberto Ruano-Ravina
- Preventive Medicine and Public Health Area, CIBERESP, Santiago de Compostela University, Madrid, Spain
| | - David Aguiar
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - Josep Gumá
- Department of Medical Oncology, Institut d'Oncologia de la Catalunya Sud, Hospital Universitari Sant Joan de Reus, IISPV-URV, Tarragona, Spain
| | - Cristina Q Blanco
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Francisco R García Arroyo
- Department of Medical Oncology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Yago Garitaonaindia
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Spain
| | - Zaida Provencio
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Spain
| | - Virginia Calvo
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Spain
| | | | - Mariano Provencio
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Spain
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23
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How I treat nodular lymphocyte-predominant Hodgkin lymphoma. Blood 2020; 136:2987-2993. [DOI: 10.1182/blood.2019004044] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/25/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma entity with distinct pathologic and clinical characteristics. Unlike the malignant cells in classical Hodgkin lymphoma, the disease-defining lymphocyte-predominant cells in NLPHL are consistently positive for CD20, but do not express CD30. The clinical course of NLPHL is indolent in the majority of cases. Most patients present with early-stage disease at the initial diagnosis. First-line treatment of stage IA NLPHL usually consists of limited-field radiotherapy alone. Patients with early-stage NLPHL other than stage IA and intermediate-stage disease mostly receive combined-modality treatment, whereas individuals with advanced NLPHL are treated with chemotherapy alone. In relapsed NLPHL, conventional chemotherapy, anti-CD20 antibodies, and radiotherapy represent active treatment modalities. Only patients with poor-risk characteristics such as early disease recurrence are candidates for aggressive salvage treatment with high-dose chemotherapy and autologous stem cell transplantation. The overall and relative survival of patients with NLPHL is excellent as indicated by a low excess mortality compared with the general population. This article discusses treatment options for patients with NLPHL and factors that influence the choice of therapy on the basis of the available data and 2 clinical cases.
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24
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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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25
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Inui R, Saito K, Shimomura Y, Yamashita D, Kawamoto M, Ishikawa T. Anti-Ma-associated paraneoplastic cerebellar degeneration in a patient with nodular lymphocyte-predominant Hodgkin lymphoma: a case report. BMC Neurol 2020; 20:355. [PMID: 32967629 PMCID: PMC7513504 DOI: 10.1186/s12883-020-01929-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paraneoplastic cerebellar degeneration (PCD) is a devastating paraneoplastic syndrome that occasionally occurs in patients with Hodgkin lymphoma (HL). Anti-Ma2 is a well-characterized onconeuronal antibody and one of the causes of PCD. There has been only one previous report of anti-Ma2-associated paraneoplastic syndrome as a complication of HL. Here we present a rare case of anti-Ma2-associated PCD in a patient with nodular lymphocyte-predominant HL (NLPHL). CASE PRESENTATION A 77-year-old man with a 3-month history of gait instability and a 2-month history of oscillopsia was referred to our hospital for further investigation. On examination, his cognition was normal. He had nystagmus in all directions of gaze; specifically, he had horizontal and rotatory nystagmus in the primary position, downbeat nystagmus after right, left, and up gaze, and upbeat nystagmus after down gaze. Although his limb ataxia was mild, his trunk ataxia was so pronounced that he was unable to walk without support. We strongly suspected paraneoplastic syndrome and tested for neuronal autoantibodies. The anti-Ma2 antibody was strongly positive in the blood and cerebrospinal fluid but other antineuronal autoantibodies were negative. Computed tomography showed an enlarged lymph node in the right axilla but no masses. Biopsy confirmed a diagnosis of NLPHL. The NLPHL cells stained with anti-Ma-2 antibody in the cytoplasm, suggesting these abnormal cells contained protein that was cross-reactive with Ma-2. CONCLUSIONS To the best of our knowledge, this is the first case of anti-Ma2-associated PCD in a patient with NLPHL that was confirmed using immunostaining of the lymph node tissue with anti-Ma2 antibody. Our case confirms an association between anti-Ma2-associated PCD and NLPHL.
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Affiliation(s)
- Ryoma Inui
- Department of Neurology, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Kenki Saito
- Department of Hematology, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yoshimitsu Shimomura
- Department of Hematology, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Daisuke Yamashita
- Department of Pathology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Michi Kawamoto
- Department of Neurology, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Takayuki Ishikawa
- Department of Hematology, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
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26
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Eichenauer DA, Plütschow A, Fuchs M, Sasse S, Baues C, Böll B, von Tresckow B, Diehl V, Borchmann P, Engert A. Long-Term Follow-Up of Patients With Nodular Lymphocyte-Predominant Hodgkin Lymphoma Treated in the HD7 to HD15 Trials: A Report From the German Hodgkin Study Group. J Clin Oncol 2020; 38:698-705. [DOI: 10.1200/jco.19.00986] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The optimal treatment of newly diagnosed nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is ill defined. We therefore conducted a retrospective analysis using the database of the German Hodgkin Study Group (GHSG). PATIENTS AND METHODS The long-term course of 471 patients with NLPHL (early stages, n = 251; intermediate stages, n = 76; advanced stages, n = 144) who had received stage-adapted first-line treatment in the randomized GHSG HD7 to HD15 studies was investigated. Treatment consisted of radiotherapy alone, chemotherapy alone, or combined-modality approaches. RESULTS The median age at NLPHL diagnosis was 39 years (range, 16 to 75 years). Patients were mostly male (75.8%). The median observation time was 9.2 years. At 10 years, progression-free survival and overall survival estimates were 75.5% and 92.1% (early stages, 79.7% and 93.3%; intermediate stages, 72.1% and 96.2%; advanced stages, 69.8% and 87.4%), respectively. A total of 48 patients (10.2%) developed a second malignancy during follow-up (non-Hodgkin lymphoma, n = 13; leukemia, n = 6; solid tumor, n = 25; unspecified malignancy, n = 4). Death occurred in 43 patients (9.1%). However, only a minority of deaths were NLPHL related (n = 10), whereas second malignancies (n = 20) and nonmalignant conditions possibly associated with radiotherapy or chemotherapy (n = 13) caused the death in the majority of patients. CONCLUSION The overall outcome of patients with NLPHL who had received Hodgkin lymphoma–directed first-line treatment in randomized GHSG trial protocols was good. Nonetheless, treatment optimization is still necessary to reduce toxicity in standard-risk patients and to improve the prognosis in high-risk patients.
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Affiliation(s)
- Dennis A. Eichenauer
- University of Cologne and Center for Integrated Oncology Aachen Bonn Dusseldorf, Cologne, Germany
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
| | - Annette Plütschow
- University of Cologne and Center for Integrated Oncology Aachen Bonn Dusseldorf, Cologne, Germany
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
| | - Michael Fuchs
- University of Cologne and Center for Integrated Oncology Aachen Bonn Dusseldorf, Cologne, Germany
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
| | - Stephanie Sasse
- University of Cologne and Center for Integrated Oncology Aachen Bonn Dusseldorf, Cologne, Germany
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
| | - Christian Baues
- University of Cologne and Center for Integrated Oncology Aachen Bonn Dusseldorf, Cologne, Germany
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
| | - Boris Böll
- University of Cologne and Center for Integrated Oncology Aachen Bonn Dusseldorf, Cologne, Germany
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
| | - Bastian von Tresckow
- University of Cologne and Center for Integrated Oncology Aachen Bonn Dusseldorf, Cologne, Germany
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
| | - Peter Borchmann
- University of Cologne and Center for Integrated Oncology Aachen Bonn Dusseldorf, Cologne, Germany
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
| | - Andreas Engert
- University of Cologne and Center for Integrated Oncology Aachen Bonn Dusseldorf, Cologne, Germany
- German Hodgkin Study Group and University Hospital Cologne, Cologne, Germany
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Hartmann S, Plütschow A, Mottok A, Bernd H, Feller AC, Ott G, Cogliatti S, Fend F, Quintanilla‐Martinez L, Stein H, Klapper W, Möller P, Rosenwald A, Engert A, Hansmann M, Eichenauer DA. The time to relapse correlates with the histopathological growth pattern in nodular lymphocyte predominant Hodgkin lymphoma. Am J Hematol 2019; 94:1208-1213. [PMID: 31396979 DOI: 10.1002/ajh.25607] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 01/03/2023]
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) can present with different histopathological growth patterns. The impact of these histopathological growth patterns on relapse characteristics is unknown. We therefore analyzed paired biopsies obtained at initial diagnosis and relapse from 33 NLPHL patients who had received first-line treatment within German Hodgkin Study Group (GHSG) trial protocols, and from a second cohort of 41 relapsed NLPHL patients who had been treated outside GHSG studies. Among the 33 GHSG patients, 21 patients presented with a typical growth pattern at initial diagnosis, whereas 12 patients had a variant histology. The histopathological growth patterns at initial diagnosis and at relapse were consistent in 67% of cases. A variant histology at initial diagnosis was associated with a shorter median time to lymphoma recurrence (2.8 vs 5.2 years; P = .0219). A similar tendency towards a shorter median time to lymphoma recurrence was observed for patients presenting with a variant histology at relapse, irrespective of the growth pattern at initial diagnosis. Results obtained from the 41 NLPHL patients who had been treated outside GHSG studies were comparable (median time to lymphoma recurrence for variant histology vs typical growth pattern at initial diagnosis: 1.5 vs 7.0 years). In conclusion, the histopathological growth pattern remains consistent at relapse in the majority of NLPHL cases, and has major impact on the time of relapse.
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Affiliation(s)
- Sylvia Hartmann
- Senckenberg Institute of PathologyGoethe University Frankfurt am Main Germany
- Reference and Consultation Center for Lymph Node and Lymphoma PathologyGoethe University Frankfurt am Main Germany
| | - Annette Plütschow
- First Department of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne Cologne Germany
- German Hodgkin Study GroupUniversity Hospital Cologne Cologne Germany
| | - Anja Mottok
- Institute of PathologyUniversity of Würzburg and Comprehensive Cancer Center (CCC) Mainfranken Würzburg Germany
- Institute of Human GeneticsUlm University and Ulm University Medical Center Ulm Germany
| | | | | | - German Ott
- Department of Clinical PathologyRobert‐Bosch‐Krankenhaus and Dr Margarete Fischer‐Bosch Institute of Clinical Pharmacology Stuttgart Germany
| | - Sergio Cogliatti
- Institute of PathologyKantonsspital St. Gallen St. Gallen Switzerland
| | - Falko Fend
- Institute of PathologyEberhard Karls University Tübingen Tübingen Germany
| | | | - Harald Stein
- Pathodiagnostic Berlin, Berlin Reference Center for Lymphoma and Hematopathology Berlin Germany
| | - Wolfram Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node RegistryUniversity Hospital Schleswig‐Holstein Campus Kiel Kiel Germany
| | - Peter Möller
- Institute of PathologyUniversity Hospital Ulm Ulm Germany
| | - Andreas Rosenwald
- Institute of PathologyUniversity of Würzburg and Comprehensive Cancer Center (CCC) Mainfranken Würzburg Germany
| | - Andreas Engert
- First Department of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne Cologne Germany
- German Hodgkin Study GroupUniversity Hospital Cologne Cologne Germany
| | - Martin‐Leo Hansmann
- Senckenberg Institute of PathologyGoethe University Frankfurt am Main Germany
- Reference and Consultation Center for Lymph Node and Lymphoma PathologyGoethe University Frankfurt am Main Germany
- Frankfurt Institute of Advanced Studies Frankfurt am Main Germany
| | - Dennis A. Eichenauer
- First Department of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne Cologne Germany
- German Hodgkin Study GroupUniversity Hospital Cologne Cologne Germany
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Eichenauer DA, Plütschow A, Fuchs M, Hartmann S, Hansmann ML, Böll B, von Tresckow B, Borchmann P, Engert A. Rituximab in newly diagnosed stage IA nodular lymphocyte-predominant Hodgkin lymphoma: long-term follow-up of a phase 2 study from the German Hodgkin Study Group. Leukemia 2019; 34:953-956. [DOI: 10.1038/s41375-019-0609-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022]
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Spinner MA, Varma G, Advani RH. Modern principles in the management of nodular lymphocyte-predominant Hodgkin lymphoma. Br J Haematol 2018; 184:17-29. [DOI: 10.1111/bjh.15616] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Michael A. Spinner
- Division of Oncology; Department of Medicine; Stanford University; Stanford CA USA
| | - Gaurav Varma
- Department of Medicine; New York-Presbyterian Hospital/Weill Cornell Medicine; New York NY USA
| | - Ranjana H. Advani
- Division of Oncology; Department of Medicine; Stanford University; Stanford CA USA
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J. Bröckelmann* P, A. Eichenauer* D, Jakob T, Follmann M, Engert A, Skoetz N. Hodgkin Lymphoma in Adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:535-540. [PMID: 30149835 PMCID: PMC6131364 DOI: 10.3238/arztebl.2018.0535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hodgkin lymphoma is the most common neoplasm in young adults, with an incidence of 2 to 3 cases per 100 000 persons per year. Risk-adapted chemotherapy and radiotherapy usually lead to cure. Finding ways to lessen the treatment- associated morbidity and mortality is a major goal of current research. METHODS For the creation of an updated guideline (DKH grant number 111778), a systematic literature search was carried out in medical databases (MEDLINE, CENTRAL) and guideline databases (GIN) (search dates: January 2012 to June 2017). RESULTS Results from 10 meta-analyses, 89 randomized and controlled trials, and 81 prospective or retrospective trials were evaluated. The use of positron emission tomography (PET) is strongly recommended in the initial diagnostic evaluation, as well as for the guidance of treatment in advanced stages. In early stages, two cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and involved-site radiotherapy (IS-RT) at a dose of 20 Gy are recommended. For the treatment of intermedi- ate stages, two cycles of escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) + two cycles of ABVD and 30 Gy IS-RT are recommended. In advanced stages, two cycles of escalated BEACOPP are administered, and then PET is performed for the guidance of further treatment: two further cycles of escalated BEACOPP are recommended if the PET is negative and four further cycles if it is positive, followed by radiotherapy of PET- positive residual tumor tissue. The five-year survival of patients with Hodgkin lymphoma is 95%. In case of disease recurrence, high-dose chemotherapy followed by autologous stem-cell transplantation is performed, and targeted drugs including brentuxi- mab vedotin, nivolumab, and pembrolizuab are used. CONCLUSION The highly favorable long-term prognosis of HL necessitates careful consideration of the intensity of treatment as well as thorough follow-up to enable the detection of late sequelae, such as second tumors or organ damage.
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Affiliation(s)
- Paul J. Bröckelmann*
- * Joint first authors
- Department I of Internal Medicine, University Hospital Cologne
- German Hodgkin Study Group (GHSG), University Hospital Cologne
| | - Dennis A. Eichenauer*
- * Joint first authors
- Department I of Internal Medicine, University Hospital Cologne
- German Hodgkin Study Group (GHSG), University Hospital Cologne
| | - Tina Jakob
- Department I of Internal Medicine, University Hospital Cologne
- Evidence-based Oncology, University Hospital Cologne
| | - Markus Follmann
- German Guideline Program in Oncology of the German Cancer Society, Berlin
| | - Andreas Engert
- Department I of Internal Medicine, University Hospital Cologne
- German Hodgkin Study Group (GHSG), University Hospital Cologne
| | - Nicole Skoetz
- Department I of Internal Medicine, University Hospital Cologne
- Evidence-based Oncology, University Hospital Cologne
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32
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Relapsed and refractory nodular lymphocyte-predominant Hodgkin lymphoma: an analysis from the German Hodgkin Study Group. Blood 2018; 132:1519-1525. [PMID: 30064977 DOI: 10.1182/blood-2018-02-836437] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022] Open
Abstract
The optimal treatment of patients with relapsed or refractory nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is ill defined. To shed more light on treatment options and outcome, we performed an analysis using the database of the German Hodgkin Study Group (GHSG). Ninety-nine patients who had received first-line treatment within 12 prospective GHSG studies conducted between 1993 and 2009, and subsequently developed disease recurrence (n = 91) or had primary disease progression (n = 8), were included. At initial NLPHL diagnosis, the median age was 40 years and 76% of patients were male. First-line treatment consisted of radiotherapy (RT) alone (20%), chemotherapy with or without RT (74%), and the anti-CD20 antibody (Ab) rituximab (6%), respectively. The median follow-up from initial diagnosis was 11.2 years. The median time to disease recurrence was 3.7 years. The applied salvage approaches included single-agent anti-CD20 Ab treatment or RT alone (37%), conventional chemotherapy (CT) with or without anti-CD20 Ab treatment with or without RT (27%) and high-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) (31%). No salvage treatment was given in 4% of patients. The 5-year progression-free survival and overall survival estimates after NLPHL recurrence were 75.6% and 89.5% (74.1% and 97.2% after single-agent anti-CD20 Ab treatment or RT alone; 68.0% and 77.8% after CT with or without anti-CD20 Ab treatment with or without RT; 84.6% and 89.8% after HDCT and ASCT). Hence, patients with relapsed or refractory NLPHL had a good overall prognosis. Factors such as time to disease recurrence and previous treatment may guide the choice of the optimal salvage approach for the individual patient.
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