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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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El Hussein S, Fang H, Jelloul FZ, Wang W, Loghavi S, Miranda RN, Friedberg JW, Burack WR, Evans AG, Xu J, Medeiros LJ. T-Cell-Rich Hodgkin Lymphoma With Features of Classic Hodgkin Lymphoma and Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Borderline Category With Overlapping Morphologic and Immunophenotypic Features. Arch Pathol Lab Med 2024; 148:914-920. [PMID: 38059511 DOI: 10.5858/arpa.2023-0133-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 12/08/2023]
Abstract
CONTEXT.— It is known that a subset of cases of classic Hodgkin lymphoma (CHL) with B-cell-rich nodules (lymphocyte-rich CHL) exhibits morphologic and immunophenotypic features that overlap with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), raising diagnostic difficulties that can be resolved in most cases by performing an adequate battery of immunohistochemical studies. OBJECTIVE.— To fully characterize cases of T-cell-rich Hodgkin lymphoma where a specific diagnosis of NLPHL (ie, pattern D) or CHL could not be made even after complete immunophenotypic investigation. DESIGN.— The clinical, immunomorphologic, and molecular (when applicable) presentation of 3 cases of T-cell-rich Hodgkin lymphoma was thoroughly investigated. RESULTS.— These 3 cases harbored lymphocyte-predominant-like and Hodgkin and Reed-Sternberg-like cells that partially expressed B-cell and CHL markers and were negative for Tiftein-Barr virus-encoded small RNA, in a T-cell-rich background with residual follicular dendritic cell meshworks; 1 case had frequent and the other 2 cases scant/absent eosinophils and plasma cells. Two patients with advanced-stage (III or IV) disease presented with axillary and supraclavicular lymphadenopathy, respectively, and without B symptoms. These patients underwent NLPHL-like therapeutic management with 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride [hydroxydaunorubicin], vincristine sulfate [Oncovin], and prednisone) chemotherapy; both are in complete remission 7 years posttherapy. One patient presented with stage I disease involving an internal mammary lymph node without B-symptoms and was treated with surgical excision alone; this patient is also in complete remission 1 year later. CONCLUSIONS.— These cases illustrate overlapping features of T-cell-rich NLPHL and CHL with neoplastic cells expressing both B-cell program and CHL markers. This underrecognized overlap has not been fully illustrated in the literature, although it portrays a therapeutic challenge. These neoplasms may deserve in-depth investigation in the future that may bring up diagnostic or theragnostic implications.
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Affiliation(s)
- Siba El Hussein
- the Department of Pathology (El Hussein, Burack, Evans), and the Wilmot Cancer Institute (Friedberg), University of Rochester Medical Center, Rochester, New York
| | - Hong Fang
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Jelloul, Wang, Loghavi, Miranda, Xu, Medeiros)
| | - Fatima Zahra Jelloul
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Jelloul, Wang, Loghavi, Miranda, Xu, Medeiros)
| | - Wei Wang
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Jelloul, Wang, Loghavi, Miranda, Xu, Medeiros)
| | - Sanam Loghavi
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Jelloul, Wang, Loghavi, Miranda, Xu, Medeiros)
| | - Roberto N Miranda
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Jelloul, Wang, Loghavi, Miranda, Xu, Medeiros)
| | - Jonathan W Friedberg
- the Department of Pathology (El Hussein, Burack, Evans), and the Wilmot Cancer Institute (Friedberg), University of Rochester Medical Center, Rochester, New York
| | - W Richard Burack
- the Department of Pathology (El Hussein, Burack, Evans), and the Wilmot Cancer Institute (Friedberg), University of Rochester Medical Center, Rochester, New York
| | - Andrew G Evans
- the Department of Pathology (El Hussein, Burack, Evans), and the Wilmot Cancer Institute (Friedberg), University of Rochester Medical Center, Rochester, New York
| | - Jie Xu
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Jelloul, Wang, Loghavi, Miranda, Xu, Medeiros)
| | - L Jeffrey Medeiros
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Jelloul, Wang, Loghavi, Miranda, Xu, Medeiros)
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3
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Binkley MS, Flerlage JE, Savage KJ, Akhtar S, Steiner R, Zhang XY, Dickinson M, Prica A, Major A, Hendrickson PG, Hopkins D, Ng A, Casulo C, Baron J, Roberts KB, Al Kendi J, Balogh A, Ricardi U, Torka P, Specht L, De Silva R, Pickard K, Blazin LJ, Henry M, Smith CM, Halperin D, Brady J, Brennan B, Senchenko MA, Reeves M, Hoppe BS, Terezakis S, Talaulikar D, Picardi M, Kirova Y, Fergusson P, Hawkes EA, Lee D, Doo NW, Barraclough A, Cheah CY, Ku M, Hamad N, Mutsando H, Gilbertson M, Marconi T, Viiala N, Maurer MJ, Eichenauer DA, Hoppe RT. International Prognostic Score for Nodular Lymphocyte-Predominant Hodgkin Lymphoma. J Clin Oncol 2024; 42:2271-2280. [PMID: 38531001 DOI: 10.1200/jco.23.01655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 01/11/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare cancer, and large international cooperative efforts are needed to evaluate the significance of clinical risk factors and immunoarchitectural patterns (IAPs) for all stages of pediatric and adult patients with NLPHL. METHODS Thirty-eight institutions participated in the Global nLPHL One Working Group retrospective study of NLPHL cases from 1992 to 2021. We measured progression-free survival (PFS), overall survival (OS), transformation rate, and lymphoma-specific death rate. We performed uni- and multivariable (MVA) Cox regression stratified by management to select factors for the lymphocyte-predominant international prognostic score (LP-IPS) validated by five-fold cross-validation. RESULTS We identified 2,243 patients with a median age of 37 years (IQR, 23-51). The median follow-up was 6.3 years (IQR, 3.4-10.8). Most had stage I to II (72.9%) and few B symptoms (9.9%) or splenic involvement (5.4%). IAP was scored for 916 (40.8%). Frontline management included chemotherapy alone (32.4%), combined modality therapy (30.5%), radiotherapy alone (24.0%), observation after excision (4.6%), rituximab alone (4.0%), active surveillance (3.4%), and rituximab and radiotherapy (1.1%). The PFS, OS, transformation, and lymphoma-specific death rates at 10 years were 70.8%, 91.6%, 4.8%, and 3.3%, respectively. On MVA, IAPs were not associated with PFS or OS, but IAP E had higher risk of transformation (hazard ratio [HR], 1.81; P < .05). We developed the LP-IPS with 1 point each for age ≥45 years, stage III-IV, hemoglobin <10.5 g/dL, and splenic involvement. Increasing LP-IPS was significantly associated with worse PFS (HR, 1.52) and OS (HR, 2.31) and increased risk of lymphoma-specific death (HR, 2.63) and transformation (HR, 1.41). CONCLUSION In this comprehensive study of all ages of patients with NLPHL, we develop the LP-IPS to identify high-risk patients and inform upcoming prospective clinical trials evaluating de-escalation of therapy for patients with low LP-IPS scores (<2).
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Affiliation(s)
- Michael Sargent Binkley
- Department of Radiation Oncology, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Jamie E Flerlage
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Saad Akhtar
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Raphael Steiner
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Anca Prica
- Princess Margaret Cancer Centre, Toronto, Canada
| | | | | | - David Hopkins
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Andrea Ng
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lena Specht
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Ravindu De Silva
- Norfolk and Norwich University Hospital, Norfolk, United Kingdom
| | - Keir Pickard
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Lindsay J Blazin
- Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Daniel Halperin
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Jessica Brady
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Maria Anatolevna Senchenko
- Oncology and Immunology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Moscow, Russian Federation
| | - Marie Reeves
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Bradford S Hoppe
- University of Florida, Gainesville, FL
- Mayo Clinic, Jacksonville, FL
| | | | - Dipti Talaulikar
- Canberra Health Services, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, AOU Federico II, Naples, Italy
| | | | | | - Eliza A Hawkes
- Olivia Newton-John Cancer Research Centre at Austin Health, Melbourne, Australia
- Lymphoma and Related Diseases Registry, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise Lee
- Austin Hospital, Eastern Health, Melbourne, Australia
| | - Nicole Wong Doo
- Lymphoma and Related Diseases Registry, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Concord Hospital, Concord Clinical School, University of Sydney, Sydney, Australia
| | | | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, Australia
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Howard Mutsando
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- University of Queensland Rural Clinical School, Toowoomba, Australia
| | | | | | - Nicholas Viiala
- Department of Haematology, Liverpool Hospital, Liverpool, Australia
- South West Sydney Clinical School, UNSW Medicine, Liverpool, Australia
| | - Matthew J Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Dennis A Eichenauer
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, German Hodgkin Study Group, Cologne, Germany
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford School of Medicine, Stanford University, Stanford, CA
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4
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Weiss J, Gibbons K, Ehyaee V, Perez-Silos V, Zevallos A, Maienschein-Cline M, Brister E, Sverdlov M, Shah E, Balakrishna J, Symes E, Frederiksen JK, Gann PH, Post R, Lopez-Hisijos N, Reneau J, Venkataraman G, Bailey N, Brown NA, Xu ML, Wilcox RA, Inamdar K, Murga-Zamalloa C. Specific Polo-Like Kinase 1 Expression in Nodular Lymphocyte-Predominant Hodgkin Lymphoma Suggests an Intact Immune Surveillance Program. THE AMERICAN JOURNAL OF PATHOLOGY 2024; 194:165-178. [PMID: 37923249 PMCID: PMC10768536 DOI: 10.1016/j.ajpath.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/27/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare and relatively indolent B-cell lymphoma. Characteristically, the [lymphocyte-predominant (LP)] tumor cells are embedded in a microenvironment enriched in lymphocytes. More aggressive variants of mature B-cell and peripheral T-cell lymphomas exhibit nuclear expression of the polo-like kinase 1 (PLK1) protein, stabilizing MYC (alias c-myc) and associated with worse clinical outcomes. This study demonstrated expression of PLK1 in the LP cells in 100% of NLPHL cases (n = 76). In contrast, <5% of classic Hodgkin lymphoma cases (n = 70) showed PLK1 expression within the tumor cells. Loss-of-function approaches demonstrated that the expression of PLK1 promoted cell proliferation and increased MYC stability in NLPHL cell lines. Correlation with clinical parameters revealed that the increased expression of PLK1 was associated with advanced-stage disease in patients with NLPHL. A multiplex immunofluorescence panel coupled with artificial intelligence algorithms was used to correlate the composition of the tumor microenvironment with the proliferative stage of LP cells. The results showed that LP cells with PLK1 (high) expression were associated with increased numbers of cytotoxic and T-regulatory T cells. Overall, the findings demonstrate that PLK1 signaling increases NLPHL proliferation and constitutes a potential vulnerability that can be targeted with PLK1 inhibitors. An active immune surveillance program in NLPHL may be a critical mechanism limiting PLK1-dependent tumor growth.
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Affiliation(s)
- Jonathan Weiss
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kathryn Gibbons
- Department of Pathology, Henry Ford Hospital, Detroit, Michigan
| | - Vida Ehyaee
- Department of Pathology, Rush University, Chicago, Illinois
| | - Vanessa Perez-Silos
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Alejandro Zevallos
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Eileen Brister
- Research Tissue Imaging Core and Research Histology Core, University of Illinois at Chicago, Chicago, Illinois
| | - Maria Sverdlov
- Research Tissue Imaging Core and Research Histology Core, University of Illinois at Chicago, Chicago, Illinois
| | - Eshana Shah
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Emily Symes
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - John K Frederiksen
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Peter H Gann
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Robert Post
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | | | - John Reneau
- Department of Internal Medicine, Ohio State University, Columbus, Ohio
| | | | - Nathanael Bailey
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Noah A Brown
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Mina L Xu
- Department of Pathology, Yale University, New Haven, Connecticut
| | - Ryan A Wilcox
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kedar Inamdar
- Department of Pathology, Henry Ford Hospital, Detroit, Michigan.
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5
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Thurner L, Fadle N, Regitz E, Roth S, Cetin O, Kos IA, Hess SM, Bein J, Bohle RM, Vornanen M, Sundström C, De Leval L, Tiacci E, Borchmann P, Engert A, Poeschel V, Held G, Schwarz EC, Neumann F, Preuss KD, Hoth M, Küppers R, Lehman K, Hansmann ML, Becker SL, Bewarder M, Hartmann S. B-cell receptor reactivity against Rothia mucilaginosa in nodular lymphocyte-predominant Hodgkin lymphoma. Haematologica 2023; 108:3347-3358. [PMID: 37139600 PMCID: PMC10690923 DOI: 10.3324/haematol.2023.282698] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a Hodgkin lymphoma expressing functional B-cell receptors (BCR). Recently, we described a dual stimulation model of IgD+ lymphocyte-predominant cells by Moraxella catarrhalis antigen RpoC and its superantigen MID/hag, associated with extralong CDR3 and HLA-DRB1*04 or HLADRB1* 07 haplotype. The aim of the present study was to extend the antigen screening to further bacteria and viruses. The fragment antibody-binding (Fab) regions of seven new and 15 previously reported cases were analyzed. The reactivity of non-Moraxella spp.-reactive Fab regions against lysates of Rothia mucilaginosa was observed in 5/22 (22.7%) cases. Galactofuranosyl transferase (Gltf) and 2,3-butanediol dehydrogenase (Bdh) of R. mucilaginosa were identified by comparative silver- and immuno-staining in two-dimensional gels, with subsequent mass spectrometry and validation by western blots and enzyme-linked immunosorbent assay. Both R. mucilaginosa Gltf and Bdh induced BCR pathway activation and proliferation in vitro. Apoptosis was induced by recombinant Gltf/ETA'-immunotoxin conjugates in DEV cells expressing recombinant R. mucilaginosa-reactive BCR. Reactivity against M. catarrhalis RpoC was confirmed in 3/7 newly expressed BCR (total 10/22 reactive to Moraxella spp.), resulting in 15/22 (68.2%) cases with BCR reactivity against defined bacterial antigens. These findings strengthen the hypothesis of bacterial trigger contributing to subsets of NLPHL.
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Affiliation(s)
- Lorenz Thurner
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar.
| | - Natalie Fadle
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar
| | - Evi Regitz
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar
| | - Sophie Roth
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg
| | - Onur Cetin
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar
| | - Igor Age Kos
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar
| | - Simon Mauro Hess
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar
| | - Julia Bein
- Dr. Senckenberg Institute of Pathology, Goethe University Hospital of Frankfurt am Main, Theodor-Stern-Kai
| | - Rainer Maria Bohle
- Saarland University Medical School, Institute of Pathology, Homburg/Saar
| | - Martine Vornanen
- Department of Pathology, Tampere University Hospital and University of Tampere, Tampere 33520, Finland.
| | - Christer Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden.
| | | | - Enrico Tiacci
- Institute of Hematology, Ospedale S. Maria della Misericordia, and the Department of Medicine, University of Perugia
| | - Peter Borchmann
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne.
| | - Andreas Engert
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne.
| | - Viola Poeschel
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar
| | - Gerhard Held
- Department of Internal Medicine 1, Westpfalz-Klinikum, Kaiserslautern
| | - Eva C Schwarz
- Department of Biophysics, Center for Integrative Physiology and Molecular Medicine, Medical Faculty, Saarland University, Homburg
| | - Frank Neumann
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar
| | - Klaus-Dieter Preuss
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar
| | - Markus Hoth
- Department of Biophysics, Center for Integrative Physiology and Molecular Medicine, Medical Faculty, Saarland University, Homburg
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Medical School, Essen, Germany; and Deutsches Konsortium für translationale Krebsforschung (DKTK)
| | | | - Martin-Leo Hansmann
- Frankfurt Institute for Advanced Studies, Frankfurt am Main, Germany; Institute of Pathology and Molecular Pathology, Helios University Hospital Wuppertal
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg
| | - Moritz Bewarder
- José Carreras Center for Immuno-and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg/Saar
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Hospital of Frankfurt am Main, Theodor-Stern-Kai
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6
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Rogness VM, Wei W, Cortese M, Hill BT. Impact of active surveillance at time of diagnosis on overall survival in nodular lymphocyte-predominant Hodgkin lymphoma: A National Cancer Database study. Leuk Res 2023; 134:107402. [PMID: 37778305 DOI: 10.1016/j.leukres.2023.107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Victoria M Rogness
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Wei Wei
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Cortese
- Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, OH, USA
| | - Brian T Hill
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA; Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, OH, USA.
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7
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Dourthe ME, Simonin M, Rigaud C, Haouy S, Montravers F, Ducou Le Pointe H, Garnier N, Minard-Colin V, Jo Molina T, Boudjemaa S, Leblanc T, Landman-Parker J. [Strategy of the French Society of Childhood Cancer (SFCE) for pediatric nodular lymphocyte predominant lymphoma]. Bull Cancer 2023; 110:968-977. [PMID: 37062647 DOI: 10.1016/j.bulcan.2023.03.006] [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: 01/10/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/18/2023]
Abstract
Nodular Lymphocyte predominant Hodgkin lymphoma (NLPHL) are rare lymphomas in pediatric patients comprising less than 10 % of all Hodgkin lymphoma (HL). They are for the most part diagnosed at stage I or II and indolent with lymphadenopathy often preceding the diagnosis by many months/years. Survival is excellent. Historically, patients were treated according to classical HL protocols. Due to high toxicity and excellent prognosis, management of NLPHL shifted to de-escalation protocol with good results. No treatment beyond surgical resection was proposed for localized unique nodal disease completely resected. The closed European protocol (EuroNet PHL LP1) evaluated the efficacy of low intensity chemotherapy protocol based on CVP courses (cyclophosphamide vinblastine prednisone) for stage IA/IIA not fully resected. Final results are not yet available. Advanced stage NLPHL are rare and there is no clinical trial and no consensus treatment in children. The SFCE lymphoma committee recently established recommendations for staging and treatment of limited and advanced NLPHL in children based on current practices and published results. The goal was to allow homogeneous practice on a national scale. If incomplete resection for patients with stage I/IIA combination of low intensity chemotherapy (CVP) and rituximab is recommended. For intermediary and advanced stage intensification with AVD (adriamycine vinblastine dacarbazine) or CHOP courses (cyclophosphamide doxorubicine vincristine prednisone) combined with rituximab are advocated. In children, there is no indication for first-line local treatment with radiotherapy.
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Affiliation(s)
- Marie Emilie Dourthe
- Université Paris Cité, hôpital universitaire Robert Debré, AP-HP, service d'immunologie et d'hématologie pédiatrique, Paris, France.
| | - Mathieu Simonin
- Sorbonne université Paris, hôpital Armand Trousseau, AP-HP, service d'hématologie pédiatrique, Paris, France
| | - Charlotte Rigaud
- Université Paris-Saclay, Gustave Roussy, département d'oncologie de l'enfant et de l'adolescent, Villejuif, France
| | - Stéphanie Haouy
- Hôpital universitaire de Montpellier, service d'hématologie et oncologie pédiatrique, Montpellier, France
| | | | - Hubert Ducou Le Pointe
- Sorbonne université, hôpital Armand Trousseau, AP-HP, service de radiologie, Paris, France
| | - Nathalie Garnier
- Hospices Civils de Lyon, institut d'hématologie et d'oncologie pédiatrique, Lyon, France
| | - Véronique Minard-Colin
- Université Paris-Saclay, Gustave Roussy, département d'oncologie de l'enfant et de l'adolescent, Villejuif, France
| | - Thierry Jo Molina
- Université Paris Cité, hôpitaux universitaires Necker Enfants Malades et Robert Debré, service d'anatomie pathologique, Paris, France
| | - Sabah Boudjemaa
- Sorbonne université, hôpital Armand Trousseau, AP-HP, service d'anatomie pathologique, Paris, France
| | - Thierry Leblanc
- Université Paris Cité, hôpital universitaire Robert Debré, AP-HP, service d'immunologie et d'hématologie pédiatrique, Paris, France
| | - Judith Landman-Parker
- Sorbonne université Paris, hôpital Armand Trousseau, AP-HP, service d'hématologie pédiatrique, Paris, France
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8
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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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9
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Nejati R, Amador C, Czader M, Thacker E, Thakkar D, Dave SS, Dogan A, Duffield A, Goodlad JR, Ott G, Wasik MA, Xiao W, Cook JR. Progression of Hodgkin lymphoma and plasma cell neoplasms: Report from the 2021 SH/EAHP Workshop. Am J Clin Pathol 2023:7135990. [PMID: 37085150 DOI: 10.1093/ajcp/aqad023] [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: 11/23/2022] [Accepted: 02/20/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES To summarize cases submitted to the 2021 Society for Hematopathology/European Association for Haematopathology Workshop under the categories of progression of Hodgkin lymphoma, plasmablastic myeloma, and plasma cell myeloma. METHODS The workshop panel reviewed 20 cases covered in this session. In addition, whole-exome sequencing (WES) and whole-genome RNA expression analysis were performed on 10 submitted cases, including 6 Hodgkin lymphoma and 4 plasma neoplasm cases. RESULTS The cases of Hodgkin lymphoma included transformed cases to or from various types of B-cell lymphoma with 1 exception, which had T-cell differentiation. The cases of plasma cell neoplasms included cases with plasmablastic progression, progression to plasma cell leukemia, and secondary B-lymphoblastic leukemia. Gene variants identified by WES included some known to be recurrent in Hodgkin lymphoma and plasma cell neoplasm. All submitted Hodgkin lymphoma samples showed 1 or more of these mutations: SOCS1, FGFR2, KMT2D, RIT1, SPEN, STAT6, TET2, TNFAIP3, and ZNF217. CONCLUSIONS Better molecular characterization of both of these neoplasms and mechanisms of progression will help us to better understand mechanisms of progression and perhaps develop better prognostic models, as well as identifying novel therapeutic targets.
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Affiliation(s)
- Reza Nejati
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Catalina Amador
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Magdalena Czader
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Devang Thakkar
- Department of Medcine, Duke University School of Medicine, Durham, NC, USA
| | - Sandeep S Dave
- Department of Medcine, Duke University School of Medicine, Durham, NC, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amy Duffield
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John R Goodlad
- Department of Pathology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr Margarete Fischer-Bosch Institute for Clinical Pharmacology, Stuttgart, Germany
| | - Mariusz A Wasik
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Wenbin Xiao
- Department of Medcine, Duke University School of Medicine, Durham, NC, USA
| | - James R Cook
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
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10
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Binkley MS, Advani RH. Treatment approaches for nodular lymphocyte-predominant Hodgkin lymphoma. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2023:S2152-2650(23)00111-8. [PMID: 37076366 DOI: 10.1016/j.clml.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/14/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare variant of Hodgkin lymphoma characterized by a persistent risk of relapse but an excellent overall survival. Historically, it was treated similarly to classic Hodgkin lymphoma, but efforts have been made to deintensify treatment due to risk of late toxicity associated with intensive therapy. For patients with completely resected stage IA NLPHL, no further treatment may be considered, particularly for pediatric patients. For those with stage I-II NLPHL without risk factors such as B symptoms, sites>2, or variant pattern histology, lower intensity treatment with radiotherapy or chemotherapy alone may be sufficient. However, combined modality therapy is a standard treatment for favorable and unfavorable risk stage I-II NLPHL associated with excellent progression-free and overall survival rates. For patients with advanced stage NLPHL, the optimal chemotherapy is not defined, but R-CHOP appears to be an effective treatment. Efforts to study NLPHL through multicenter collaborative efforts are crucial to develop evidence based and individualized treatments for patients with NLPHL.
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Affiliation(s)
- Michael S Binkley
- Department of Radiation Oncology, Stanford University, Palo Alto, CA.
| | - Ranjana H Advani
- Department of Medicine, Division of Oncology, Stanford University, Palo Alto, CA
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11
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Murayama D, Hashizume T, Hirano R, Azuhata K, Shimojo H, Ito N, Mishima O. Simultaneous nodular lymphocyte-predominant Hodgkin lymphoma with papillary thyroid carcinoma: a case report. J Surg Case Rep 2022; 2022:rjac599. [PMID: 36601095 PMCID: PMC9803968 DOI: 10.1093/jscr/rjac599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 01/01/2023] Open
Abstract
We herein report the case of a 48-year-old man diagnosed with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL, Stage IA) and papillary thyroid carcinoma (PTC, Stage I). Total thyroidectomy, left modified neck dissection and biopsy of the right cervical lymph node were performed. Postoperatively, NLPHL treatment was prioritized, and external radiation (30.6 Gy) was applied to the right neck. PTC was considered a high-risk category for recurrence due to extranodal invasion of lymph node metastasis, and radioactive iodine therapy (ablative dose, 1110 MBq) was administered. Both PTC and NLPHL showed no recurrence 18 months after surgery.
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Affiliation(s)
- Daisuke Murayama
- Correspondence address. Department of Breast and Thyroid Surgery, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan. Tel.: +81263-33-8600; Fax: +81263-32-6763; E-mail:
| | - Toko Hashizume
- Department of Breast and Thyroid Surgery, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Ryosuke Hirano
- Department of Breast and Thyroid Surgery, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Koji Azuhata
- Department of Pathology, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Hisashi Shimojo
- Department of Pathology, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Nobuo Ito
- Department of Pathology, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Osamu Mishima
- Department of Breast and Thyroid Surgery, Aizawa Hospital, Matsumoto, Nagano, Japan
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12
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Lehner B, Panny M. Hodgkin lymphoma—how much therapy do we need? MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2022. [DOI: 10.1007/s12254-022-00856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Individualized patient care in nodular lymphocyte-predominant Hodgkin lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:717-722. [PMID: 36485084 PMCID: PMC9820371 DOI: 10.1182/hematology.2022000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma that has traditionally been considered a subgroup of Hodgkin lymphoma. However, morphology, surface marker expression, genetics, and clinical course are different from classic Hodgkin lymphoma. While most patients experience indolent disease with slow progression, some patients can also have more aggressive disease. Nevertheless, outcomes are excellent, and excess mortality due to NLPHL is at most very low. The treatment of newly diagnosed NLPHL has historically mirrored that of classic Hodgkin lymphoma. However, evidence for deviations from that approach has emerged over time and is discussed herein. Less evidence is available for the optimal management of relapsed patients. So-called variant histology has recently emerged as a biological risk factor, providing at least a partial explanation for the observed heterogeneity of NLPHL. Considering variant histology together with other risk factors and careful observation of the clinical course of the disease in each patient can help to assess individual disease aggressiveness. Also important in this mostly indolent disease are the preferences of the patient and host factors, such as individual susceptibility to specific treatment side effects. Considering all this together can guide individualized treatment recommendations, which are paramount in this rare disease.
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14
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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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15
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Shankar A, Hall GW, McKay P, Gallop-Evans E, Fielding P, Collins GP. Management of children and adults with all stages of nodular lymphocyte predominant Hodgkin lymphoma - All StAGEs: A consensus-based position paper from the Hodgkin lymphoma subgroup of the UK National Cancer Research Institute. Br J Haematol 2022; 197:679-690. [PMID: 35362554 DOI: 10.1111/bjh.18169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 12/31/2022]
Abstract
A consensus statement for the management for patients of all ages with all stages of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) - All StAGEs - is proposed by representatives of the UK National Cancer Research Institute (NCRI) Hodgkin lymphoma study group and the Children's Cancer & Leukaemia Group. Based on current practices and published evidence, a consensus has been reached regarding diagnosis, staging and risk-ik7 stratified management which includes active surveillance, low- and standard-dose immunochemotherapy and radiotherapy.
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Affiliation(s)
- Ananth Shankar
- Children and Young People's Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgina W Hall
- Paediatric & Adolescent Haematology/Oncology unit, Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pam McKay
- Department of Haematology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Eve Gallop-Evans
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Patrick Fielding
- Wales Research and Diagnostic PET Imaging Centre, Department of Radiology, Cardiff, UK
| | - Graham P Collins
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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16
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Sidda A, Naleid NK, Manu G, Graffeo V, Jamil MO. Nodular Lymphocyte-Predominant Hodgkin Lymphoma: Review of Current Literature and Case Discussion. J Investig Med High Impact Case Rep 2022; 10:23247096221111767. [PMID: 35861500 PMCID: PMC9309769 DOI: 10.1177/23247096221111767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subset of Hodgkin lymphoma (HL). It has a distinct clinical and pathological presentation. Unlike classic HL, where the predominant malignant cells are Reed Sternberg cells, the malignant cells in NLPHL are known as lymphocyte predominant (LP) cells, with their own unique immunohistochemistry antigen expression and staining pattern. Based on risk stratification and staging of the disease, treatment can range from active surveillance in asymptomatic patients with no organ compromise or bulky disease, to aggressive chemotherapeutic agents in advanced disease. Guidelines on which of these chemotherapy regimens would offer the most benefit to our patients are limited due to lack of randomized-controlled studies. Majority of the current prospective data on treatment were inclusive of both HL and NLPHL. Thus, the regimens employed in treatment of NLPHL are similar to the ones used in HL, though NLPHL is often viewed as its own distinct entity. This article aims to review the current literature and future advances on treatment of this rare disease.
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Affiliation(s)
- Adarsh Sidda
- Department of Hematology & Oncology,
Marshall University, Huntington, WV, USA
| | | | - Gurusidda Manu
- Internal Medicine, University of Texas
Southwestern, Dallas, USA
| | - Vincent Graffeo
- Department of Pathology, Marshall University,
Huntington, WV, USA
| | - Muhammad Omer Jamil
- Department of Hematology & Oncology,
Marshall University, Huntington, WV, USA
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17
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Transformation and outcome of nodular lymphocyte predominant Hodgkin lymphoma: a Finnish Nationwide population-based study. Blood Cancer J 2021; 11:203. [PMID: 34923571 PMCID: PMC8684552 DOI: 10.1038/s41408-021-00586-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/03/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare B-cell malignancy associated with excellent survival. However, some patients experience histological transformation into aggressive large B-cell lymphoma. Population-based data on transformation in patients with NLPHL is limited. We conducted a nationwide population-based study to estimate the risk of transformation and relative survival in patients diagnosed with NLPHL in Finland between 1995 and 2018. We identified a total of 453 patients (median age, 48 years; 76% males) with the incident NLPHL from the Finnish Cancer Registry. The cumulative incidence of transformation was 6.3% (95% CI, 4.2-9.6) at 10 years. After adjusting for sex, age and year of diagnosis, transformation was associated with a substantially increased risk of death (HR 8.55, 95% CI 4.49−16.3). Ten-year relative survival was 94% (95% CI, 89%‒100%). The patients diagnosed at a later calendar year had lower excess risk of death (HR, 0.38 per 10-year increase; 95% CI, 0.15‒0.98). We conclude that while the 10-year relative survival for the patients with NLPHL was excellent in this large population-based cohort for the entire study period, transformation resulted in a substantially increased mortality compared with the patients without transformation. Our results also suggest a reduction in excess mortality over time.
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18
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Cheng PTM, Villa D, Tonseth RP, Scott DW, Gerrie AS, Freeman CL, Pickles T, Lo AC, Farinha P, Craig JW, Slack GW, Gascoyne RD, Bénard F, Wilson D, Skinnider B, Connors JM, Sehn LH, Savage KJ. Outcome of limited-stage nodular lymphocyte-predominant Hodgkin lymphoma and the impact of a PET-adapted approach. Blood Adv 2021; 5:3647-3655. [PMID: 34438445 PMCID: PMC8945586 DOI: 10.1182/bloodadvances.2021004375] [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] [Received: 01/29/2021] [Accepted: 04/29/2021] [Indexed: 01/05/2023] Open
Abstract
Radiotherapy (RT) is typically incorporated into the treatment of limited-stage nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), although it remains unknown whether chemotherapy alone may be suitable in select patients. We evaluated outcomes of limited-stage NLPHL at BC Cancer on the basis of era-specific guidelines: routine RT era, 1995 to 2005 (n = 36), combined modality with 2 cycles of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by RT or RT alone; positron emission tomography (PET) era, after 2005 (n = 63), ABVD alone (4 cycles) if the PET scan after the second cycle of ABVD (PET2) is negative, or treatment is changed to RT if PET2 is positive. Median age of patients was 38 years (range, 16-82 years), 73% were male, and 43% had stage II. With a median follow-up of 10.5 years for all patients, 5-year progression-free survival (PFS) was 91% [corrected] and was 97% for overall survival (OS), with no difference by treatment era (PFS, P = .15; [corrected] OS, P = .35). For the 49 patients who had a PET2 scan, 86% were PET negative and 14% were PET positive by Deauville criteria with 5-year PFS rates of 92% and 80% (P = .87) [corrected], respectively. This is the largest study of a PET-adapted approach in NLPHL and supports that ABVD alone may be a viable option in select patients with a negative PET2 scan, with consideration of acute and long-term toxicities.
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Affiliation(s)
| | - Diego Villa
- Centre for Lymphoid Cancer and Department of Medical Oncology
| | | | - David W. Scott
- Centre for Lymphoid Cancer and Department of Medical Oncology
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer and Department of Medical Oncology
| | | | | | | | - Pedro Farinha
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | - Jeffrey W. Craig
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | - Randy D. Gascoyne
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | | | | | - Brian Skinnider
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | | | - Laurie H. Sehn
- Centre for Lymphoid Cancer and Department of Medical Oncology
| | - Kerry J. Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology
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19
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Strati P, Cheng PTM, Steiner RE, Alcedo Andrade PE, Feng L, Sano D, Rao VA, Singh P, Miranda R, Gunther JR, Pinnix CC, Dabaja BS, Cuglievan B, Xing K, Villa D, Skinnider B, Sehn LH, Connors JM, Nieto Y, Ahmed S, Lee HJ, Savage KJ. Outcome of relapsed and refractory nodular lymphocyte-predominant Hodgkin lymphoma: a North American analysis. Br J Haematol 2021; 192:560-567. [PMID: 33517581 DOI: 10.1111/bjh.17281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022]
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity, with limited data on the outcome in the relapsed/refractory setting. We evaluated the outcome of all patients diagnosed between 04/1979 and 01/2019 with relapsed or progressive NLPHL after initial active therapy at two institutions, refractory disease being defined as lack of response to treatment and/or relapse within three months of treatment. NLPHL patients with histological evidence of transformation at time of first relapse or progression were excluded. In total, 69 patients with recurrent NLPHL were included in the study. After a median follow-up after initial diagnosis of 14 years (range, 0·5-46 years), median progression-free survival after front-line treatment (PFS-1) was four years. Second-line therapy included chemotherapy in 28 (41%) patients, biological therapy (rituximab, lenalidomide or brentuximab vedotin) in 14 (20%), high-dose chemotherapy followed by autologous stem cell transplant in 14 (20%) and radiation therapy (RT) alone in 10 (15%). The five-year PFS after second-line therapy (PFS-2) was 68% [95% confidence interval (CI), 54-79%] but the five-year overall survival (OS) after second-line therapy (OS-2) remained excellent, at 94% (95% CI, 85-99%). Due to excellent outcome in case of recurrence, studies aimed at characterizing its biology to guide therapy de-escalation are needed.
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Affiliation(s)
- Paolo Strati
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Phoebe T M Cheng
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Raphael E Steiner
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pedro E Alcedo Andrade
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dahlia Sano
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Veeramaneni A Rao
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Prachee Singh
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto Miranda
- Department of Hemato-Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Branko Cuglievan
- Department of Pediatric Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katharine Xing
- Department of Medical Oncology, British Columbia Cancer Center, Vancouver, BC, Canada
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Brian Skinnider
- Department of Pathology, British Columbia Cancer Center, Vancouver, BC, Canada
| | - Laurie H Sehn
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Joseph M Connors
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hun J Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kerry J Savage
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
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Bessen SY, Gardner JA, Chen EY. When is surgical resection alone appropriate treatment for pediatric nodular lymphocyte-predominant Hodgkin lymphoma? SAGE Open Med Case Rep 2021; 9:2050313X211022422. [PMID: 34377479 PMCID: PMC8327231 DOI: 10.1177/2050313x211022422] [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: 03/31/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022] Open
Abstract
The surgeon’s role in the management of lymphoma is typically limited to performing
biopsies for diagnosis. Most patients with lymphoma are treated with chemotherapy and/or
radiation, but in rare cases, lymphoma can be primarily treated with surgery. We present a
case of nodular lymphocyte-predominant Hodgkin lymphoma in a 4-year-old child with
cervical adenopathy and discuss initial treatment with surgery alone. Surgery as primary
treatment avoids the serious long-term sequelae of chemotherapy and radiation, and
reserves those options for possible future recurrences; however, this approach should be
reserved for patients with limited and low-risk disease. This case report reviews the pros
and cons of treating early-stage nodular lymphocyte-predominant Hodgkin lymphoma in a
pediatric patient with surgery alone.
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Affiliation(s)
- Sarah Y Bessen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Juli-Anne Gardner
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Eunice Y Chen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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21
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Conditional relative survival among patients with nodular lymphocyte-predominant Hodgkin lymphoma in the Netherlands. Blood Cancer J 2021; 11:87. [PMID: 33976110 PMCID: PMC8113262 DOI: 10.1038/s41408-021-00482-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/04/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022] Open
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22
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Paschold L, Willscher E, Bein J, Vornanen M, Eichenauer DA, Simnica D, Thiele B, Wickenhauser C, Rosenwald A, Bernd HW, Klapper W, Feller AC, Ott G, Fend F, Hartmann S, Binder M. Evolutionary clonal trajectories in nodular lymphocyte predominant Hodgkin lymphoma with high transformation risk. Haematologica 2021; 106:2654-2666. [PMID: 33882641 PMCID: PMC8485677 DOI: 10.3324/haematol.2021.278427] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 11/09/2022] Open
Abstract
The B cell architecture of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is complex since it is composed of malignant lymphocyte-predominant (LP) cells along with a B cell rich bystander environment. To gain insight into molecular determinants of transformation, we studied B cell evolutionary trajectories in lymphoma tissue from diagnosis to relapse or transformation to non-Hodgkin lymphoma by immunoglobulin heavy chain next-generation sequencing. NLPHL cases that later transformed showed higher age, IgD negativity, absence of the characteristic IGHV3/IGHD3/IGHJ6 LP rearrangement and high repertoire clonality. We constructed phylogenetic trees within the compartment of the malignant clone to investigate clonal evolution. In all relapsing cases, the LP rearrangement was identical at diagnosis and relapse. NLPHL cases with transformation showed more complex trajectories with strong intraclonal diversification. The dominant founder clone in transformations showed clonal evolution, if derived from the same cell of origin, or originated from a different cell of origin. Together, our data point to a significant role of antigenic drive in NLHPL transformations and identify high B cell repertoire clonality with dominant intraclonal LP cell diversification as a hallmark of transformation. Sequencing of the initial paraffin-embedded tissue may therefore be diagnostically applied to identify NLPHL cases with high transformation risk.
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Affiliation(s)
- Lisa Paschold
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale)
| | - Edith Willscher
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale)
| | - Julia Bein
- Dr. Senckenberg Institute of Pathology, Goethe University Hospital of Frankfurt Main, Theodor-Stern-Kai 7, D-60590 Frankfurt a. Main
| | - Martine Vornanen
- Department of Pathology, Tampere University Hospital and University of Tampere, Tampere 33520
| | - Dennis A Eichenauer
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, and German Hodgkin Study Group, University Hospital Cologne, Cologne
| | - Donjete Simnica
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale)
| | - Benjamin Thiele
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Claudia Wickenhauser
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle (Saale)
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg and Comprehensive Cancer Center (CCC) Mainfranken, Würzburg
| | | | - Wolfram Klapper
- Department of Pathology, Division of Hematopathology and Lymph Node Registry, Schleswig-Holstein Medical Center, Campus Kiel, Kiel
| | | | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus and Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart
| | - Falko Fend
- Institute of Pathology, Eberhard Karls University Tübingen, Tübingen
| | - Sylvia Hartmann
- Institute of Pathology, Eberhard Karls University Tübingen, Tübingen, Germany; Reference and Consultation Center for Lymph Node and Lymphoma Pathology, Goethe University, Frankfurt am Main
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale).
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23
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Straus DJ. Progress in understanding the biology of nodular lymphocyte predominant Hodgkin lymphoma. Haematologica 2021; 106:2538. [PMID: 33882643 PMCID: PMC8485658 DOI: 10.3324/haematol.2021.278785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
Not available.
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24
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Pugliese N, Picardi M, Della Pepa R, Giordano C, Muriano F, Leone A, Delle Cave G, D’Ambrosio A, Marafioti V, Rascato MG, Russo D, Mascolo M, Pane F. Rituximab-Containing Risk-Adapted Treatment Strategy in Nodular Lymphocyte Predominant Hodgkin Lymphoma: 7-Years Follow-Up. Cancers (Basel) 2021; 13:cancers13081760. [PMID: 33917062 PMCID: PMC8067750 DOI: 10.3390/cancers13081760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare variant of HL that accounts for 5% of all HL cases. The expression of CD20 on neoplastic lymphocytes provides a suitable target for novel treatments based on Rituximab. Due to its rarity, consolidated and widely accepted treatment guidelines are still lacking for this disease. METHODS Between 1 December 2007 and 28 February 2018, sixteen consecutive newly diagnosed adult patients with NLPHL received Rituximab (induction ± maintenance)-based therapy, according to the baseline risk of German Hodgkin Study Group prognostic score system. The treatment efficacy and safety of the Rituximab-group were compared to those of a historical cohort of 12 patients with NLPHL who received Doxorubicin, Bleomycin, Vinblastine, Dacarbazine (ABVD) chemotherapy followed by radiotherapy (RT), if needed, according to a similar baseline risk. The primary outcome was progression-free survival (PFS) and secondary outcomes were overall survival (OS) and side-effects (according to the Common Terminology Criteria for Adverse Events, v4.03). RESULTS After a 7-year follow-up (range, 1-11 years), PFS was 100% for patients treated with the Rituximab-containing regimen versus 66% for patients of the historical cohort (p = 0.036). Four patients in the latter group showed insufficient response to therapy. The PFS for early favorable and early unfavorable NLPHLs was similar between treatment groups, while a better PFS was recorded for advanced-stages treated with the Rituximab-containing regimen. The OS was similar for the two treatment groups. Short- and long-term side-effects were more frequently observed in the historical cohort. Grade ≥3 neutropenia was more frequent in the historical cohort compared with the Rituximab-group (58.3% vs. 18.7%, respectively; p = 0.03). Long-term non-hematological toxicities were observed more frequently in the historical cohort. CONCLUSION Our results confirm the value of Rituximab in NLPHL therapy and show that Rituximab (single-agent) induction and maintenance in a limited-stage, or Rituximab with ABVD only in the presence of risk factors, give excellent results while sparing cytotoxic agent- and/or RT-related damage. Furthermore, Rituximab inclusion in advanced-stage therapeutic strategy seems to improve PFS compared to conventional chemo-radiotherapy.
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Affiliation(s)
- Novella Pugliese
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
- Correspondence: ; Tel.: +39-0817462037
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Claudia Giordano
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Francesco Muriano
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Aldo Leone
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Giuseppe Delle Cave
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Alessandro D’Ambrosio
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Violetta Marafioti
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Maria Gabriella Rascato
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Daniela Russo
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (D.R.); (M.M.)
| | - Massimo Mascolo
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (D.R.); (M.M.)
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
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25
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Akhtar S, Rauf MS, Khafaga Y, Al-Kofide A, Elhassan TAM, Elshenawy MA, Nadri J, Mushtaq AH, Bakshi N, Shamayel M, Al-Sweedan S, Sarwar S, Maghfoor I. Nodular lymphocyte-predominant Hodgkin lymphoma characteristics, management of primary and relapsed/refractory disease and outcome analysis: the first comprehensive report from the Middle East. BMC Cancer 2021; 21:351. [PMID: 33794818 PMCID: PMC8017738 DOI: 10.1186/s12885-021-08074-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is an uncommon variant of Hodgkin lymphoma. There is limited data on treatment, management of refractory and relapsed disease, and long-term outcome. Many registries or country-wide data reports are unable to provide detailed primary and subsequent management. We are reporting our observation on patient's characteristics, management, and outcome. METHODS This single-institution retrospective cohort analysis includes NLPHL patients seen from 1998 to July 2019. We used Fisher's exact test, chi-square, and Kaplan-Meier (KM) method for various analyses. RESULTS Two hundred patients were identified, (6.34% of all the HL). Male:female was 3:1. The median age at diagnosis was 22 years (4-79 years). Stage I-II in 145 (72.5%) cases. One hundred patients (50%) received chemotherapy, 68 (34%) chemotherapy + radiation therapy (RT); 87% of all chemotherapy was ABVD (adriamycin, bleomycin, vinblastine, dacarbazine). Thirteen patients (6.5%) received RT alone and 16 (8%) had surgery alone. Complete response in 82%, partial response in 5.5% and progressive disease in 10.5%. The median follow is 60 months (5-246). Median 5 and 10 years overall survival (OS) is 94.8 and 92.4% (stages I-II, 97.7 and 97.7%, stage III-IV, 94.8 and 92.4%). Median event-free survival (EFS) is 62.3 and 54% respectively (stage I-II, 72 and 64%, stage III-IV, 36.4 and 18.2%). Stage I-II vs III-IV OS (p = < 0.001) and EFS (p = < 0.001) were significant. For stage I-II, 5 year EFS of chemotherapy + RT (83.3%) was superior to chemotherapy alone (60%, p = 0.008). Five year EFS for early favorable (80%), early unfavorable (60%), and advanced (36.4%) was significant (p = < 0.001). Eleven patients (5.5%) had high-grade transformation. Twenty-nine patients underwent HDC auto-SCT, all are alive (28 in remission). 25% of patients had pathologically proved nodal hyperplasia at some point in time. CONCLUSION OS of NLPHL is excellent and independent of treatment type. EFS is better for chemotherapy + RT than chemotherapy alone. Stem cell transplant in refractory / multiple relapses resulted in excellent disease control. There is a need to identify optimal treatment strategies accordingly to the risk stratification.
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Affiliation(s)
- Saad Akhtar
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - M Shahzad Rauf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Yasser Khafaga
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Amani Al-Kofide
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Tusneem Ahmed M Elhassan
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mahmoud A Elshenawy
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Juzer Nadri
- AlFaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | - Nasir Bakshi
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Shamayel
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Suleiman Al-Sweedan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Sohail Sarwar
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Irfan Maghfoor
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
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26
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CANDAR Ö, ÖZKALEMKAŞ F, OZKOCAMAN V, ERSAL T, PINAR İE, YALÇIN C, ORHAN B. Single center experience in patients with a diagnosis of nodular lymphocyte predominant Hodgkin lymphoma. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.877049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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27
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Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG. Blood 2021; 135:2365-2374. [PMID: 32211877 DOI: 10.1182/blood.2019003877] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/06/2020] [Indexed: 02/08/2023] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is an uncommon histologic variant, and the optimal treatment of stage I-II NLPHL is undefined. We conducted a multicenter retrospective study including patients ≥16 years of age with stage I-II NLPHL diagnosed from 1995 through 2018 who underwent all forms of management, including radiotherapy (RT), combined modality therapy (CMT; RT+chemotherapy [CT]), CT, observation after excision, rituximab and RT, and single-agent rituximab. End points were progression-free survival (PFS), freedom from transformation, and overall survival (OS) without statistical comparison between management groups. We identified 559 patients with median age of 39 years: 72.3% were men, and 54.9% had stage I disease. Median follow-up was 5.5 years (interquartile range, 3.1-10.1). Five-year PFS and OS in the entire cohort were 87.1% and 98.3%, respectively. Primary management was RT alone (n = 257; 46.0%), CMT (n = 184; 32.9%), CT alone (n = 47; 8.4%), observation (n = 37; 6.6%), rituximab and RT (n = 19; 3.4%), and rituximab alone (n = 15; 2.7%). The 5-year PFS rates were 91.1% after RT, 90.5% after CMT, 77.8% after CT, 73.5% after observation, 80.8% after rituximab and RT, and 38.5% after rituximab alone. In the RT cohort, but not the CMT cohort, variant immunoarchitectural pattern and number of sites >2 were associated with worse PFS (P < .05). Overall, 21 patients (3.8%) developed large-cell transformation, with a significantly higher transformation rate in those with variant immunoarchitectural pattern (P = .049) and number of involved sites >2 (P = .0006). OS for patients with stage I-II NLPHL was excellent after all treatments.
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28
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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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29
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Lumish M, Falchi L, Imber BS, Scordo M, von Keudell G, Joffe E. How we treat mature B-cell neoplasms (indolent B-cell lymphomas). J Hematol Oncol 2021; 14:5. [PMID: 33407745 PMCID: PMC7789477 DOI: 10.1186/s13045-020-01018-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/02/2020] [Indexed: 12/30/2022] Open
Abstract
Mature B cell neoplasms, previously indolent non-Hodgkin lymphomas (iNHLs), are a heterogeneous group of malignancies sharing similar disease courses and treatment paradigms. Most patients with iNHL have an excellent prognosis, and in many, treatment can be deferred for years. However, some patients will have an accelerated course and may experience transformation into aggressive lymphomas. In this review, we focus on management concepts shared across iNHLs, as well as histology-specific strategies. We address open questions in the field, including the influence of genomics and molecular pathway alterations on treatment decisions. In addition, we review the management of uncommon clinical entities including nodular lymphocyte-predominant Hodgkin lymphoma, hairy cell leukemia, splenic lymphoma and primary lymphoma of extranodal sites. Finally, we include a perspective on novel targeted therapies, antibodies, antibody-drug conjugates, bispecific T cell engagers and chimeric antigen receptor T cell therapy.
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Affiliation(s)
- Melissa Lumish
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Lorenzo Falchi
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Brandon S Imber
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Michael Scordo
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Gottfried von Keudell
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Erel Joffe
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA.
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30
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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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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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Poppema S. Lymphocyte predominant Hodgkin lymphoma, antigen-driven after all? J Pathol 2020; 253:1-10. [PMID: 33044742 DOI: 10.1002/path.5567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 01/12/2023]
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) was suggested as an entity separate from other types of Hodgkin lymphoma 40 years ago and recognized in the WHO classification in 2001. Based on its relatively benign course with late distant relapses, relation with lymph node hyperplasia with progressively transformed germinal centers, presence of clonal immunoglobulin gene rearrangements with somatic hypermutations and ongoing mutations, and relation with a number of inherited defects affecting the immune system, it has been suspected that NLPHL might be antigen-driven. Recent evidence has shown that cases of IgD-positive NLPHL are associated with infection by Moraxella catarrhalis, a common bacterium in the upper respiratory tract and in lymph nodes. This review summarizes the evidence for NLPHL as a B-cell lymphoma involving follicular T-lymphocytes normally found in germinal centers, its molecular features and relation to inherited immune defects, and its relation and differential diagnosis from similar entities. Finally, it discusses the evidence that in many cases a watch and wait policy might be a viable initial management strategy. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Sibrandes Poppema
- School of Medical and Health Sciences, Sunway University, Bandar Sunway, Malaysia
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33
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Histopathological and clinical features of nodular lymphocyte-predominant Hodgkin lymphoma and their impact on prognosis: first report from Iran. J Hematop 2020. [DOI: 10.1007/s12308-020-00410-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Abstract
Hodgkin lymphoma (HL) is a B cell lymphoma characterized by few malignant cells and numerous immune effector cells in the tumour microenvironment. The incidence of HL is highest in adolescents and young adults, although HL can affect elderly individuals. Diagnosis is based on histological and immunohistochemical analyses of tissue from a lymph node biopsy; the tissue morphology and antigen expression profile enable classification into one of the four types of classic HL (nodular sclerosis, mixed cellularity, lymphocyte-depleted or lymphocyte-rich HL), which account for the majority of cases, or nodular lymphocyte-predominant HL. Although uncommon, HL remains a crucial test case for progress in cancer treatment. HL was among the first systemic neoplasms shown to be curable with radiation therapy and multiagent chemotherapy. The goal of multimodality therapy is to minimize lifelong residual treatment-associated toxicity while maintaining high levels of effectiveness. Recurrent or refractory disease can be effectively treated or cured with high-dose chemotherapy followed by autologous haematopoietic stem cell transplantation, and prospective trials have demonstrated the potency of immunotherapeutic approaches with antibody-drug conjugates and immune checkpoint inhibitors. This Primer explores the wealth of information that has been assembled to understand HL; these updated observations verify that HL investigation and treatment remain at the leading edge of oncological research.
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35
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Moskowitz AJ. NLP Hodgkin lymphoma: can we get away with less? Blood 2020; 135:2329-2330. [PMID: 32585026 PMCID: PMC10405621 DOI: 10.1182/blood.2020005876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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36
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Lymphocyte predominant cells detect Moraxella catarrhalis-derived antigens in nodular lymphocyte-predominant Hodgkin lymphoma. Nat Commun 2020; 11:2465. [PMID: 32424289 PMCID: PMC7235000 DOI: 10.1038/s41467-020-16375-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma of B-cell origin with frequent expression of functional B-cell receptors (BCRs). Here we report that expression cloning followed by antigen screening identifies DNA-directed RNA polymerase beta’ (RpoC) from Moraxella catarrhalis as frequent antigen of BCRs of IgD+ LP cells. Patients show predominance of HLA-DRB1*04/07 and the IgVH genes encode extraordinarily long CDR3s. High-titer, light-chain-restricted anti-RpoC IgG1/κ-type serum-antibodies are additionally found in these patients. RpoC and MID/hag, a superantigen co-expressed by Moraxella catarrhalis that is known to activate IgD+ B cells by binding to the Fc domain of IgD, have additive activation effects on the BCR, the NF-κB pathway and the proliferation of IgD+ DEV cells expressing RpoC-specific BCRs. This suggests an additive antigenic and superantigenic stimulation of B cells with RpoC-specific IgD+ BCRs under conditions of a permissive MHC-II haplotype as a model of NLPHL lymphomagenesis, implying future treatment strategies. Nodular lymphocyte-predominant Hodgkin lymphoma with IgD+ lymphocyte-predominant (LP) cells is a rare clinical distinct lymphoma subset of B-cell origin. Here the authors show that antigens expressed by Moraxella catarrhalis are recognized by B cell receptors of IgD+ LP cells, suggesting the contribution of chronic antigen stimulation to lymphomagenesis.
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Patel CG, Ng AK. Involved-Site Radiation Therapy for Early-Stage NLPHL. Int J Radiat Oncol Biol Phys 2020; 107:21-22. [DOI: 10.1016/j.ijrobp.2019.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 08/31/2019] [Accepted: 09/13/2019] [Indexed: 11/28/2022]
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Bartlett NL. Treatment of Nodular Lymphocyte Hodgkin Lymphoma: The Goldilocks Principle. J Clin Oncol 2020; 38:662-668. [PMID: 31922929 DOI: 10.1200/jco.19.02816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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39
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Nodular lymphocyte predominant Hodgkin lymphoma: pathology, clinical course and relation to T-cell/histiocyte rich large B-cell lymphoma. Pathology 2020; 52:142-153. [DOI: 10.1016/j.pathol.2019.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 12/11/2022]
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40
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Medeiros LJ, Spagnolo DV. Lymphoma 2020: an update on recent advances in pathobiology and application to clinical practice. Pathology 2019; 52:1-5. [PMID: 31812272 DOI: 10.1016/j.pathol.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 02/06/2023]
Affiliation(s)
- L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Dominic V Spagnolo
- Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Center and the University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, WA, Australia.
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41
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Aragao A, Kilic I, Velankar MM, Pambuccian SE. "Popcorn cells" in intraoperative touch imprints of nodular lymphocyte-predominant Hodgkin lymphoma. Diagn Cytopathol 2019; 48:177-180. [PMID: 31793243 DOI: 10.1002/dc.24352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/29/2019] [Accepted: 11/14/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Alessa Aragao
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | | | - Milind M Velankar
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
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42
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Posthuma HLA, Zijlstra JM, Visser O, Lugtenburg PJ, Kersten MJ, Dinmohamed AG. Primary therapy and survival among patients with nodular lymphocyte-predominant Hodgkin lymphoma: a population-based analysis in the Netherlands, 1993-2016. Br J Haematol 2019; 189:117-121. [PMID: 31682006 PMCID: PMC7154721 DOI: 10.1111/bjh.16290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/16/2019] [Indexed: 12/02/2022]
Abstract
In this nationwide, population‐based study, we assessed trends in primary treatment and survival among 687 patients with nodular lymphocyte‐predominant Hodgkin lymphoma (75% males; median age, 40 years; and 74% stage‐I/II disease) diagnosed in the Netherlands between 1993–2016. There were no noteworthy changes in the application of primary therapy over time among adult patients across the different disease stages and age groups. Survival among various subgroups of adult patients was largely comparable to the expected survival of the general population. A particularly encouraging finding was that young adult patients experienced virtually no excess mortality, as compared to the general population.
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Affiliation(s)
- Hidde L A Posthuma
- Department of Haematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Department of Haematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | | | - Marie José Kersten
- Department of Haematology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Haematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Haematology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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43
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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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44
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To treat or not to treat, that is the NLPHL question. Blood 2019; 133:2113-2114. [PMID: 31097532 DOI: 10.1182/blood-2019-02-900811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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