Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG
Michael S. Binkley, M. Shahzad Rauf, Sarah A. Milgrom, Chelsea C. Pinnix, Richard Tsang, Michael Dickinson, Andrea K. Ng, Kenneth B. Roberts, Sarah Gao, Alex Balogh, Umberto Ricardi, Mario Levis, Carla Casulo, Michael Stolten, Lena Specht, John P. Plastaras, Christopher M. Wright, Chris R. Kelsey, J.L. Brady, N. George Mikhaeel, Bradford S. Hoppe, Stephanie Terezakis, Marco Picardi, Roberta Della Pepa, Youlia Kirova, Saad Akhtar, Irfan Maghfoor, Julie L. Koenig, Christopher Jackson, Erin J. Song, Shuchi Sehgal, Ranjana H. Advani, Yasodha Natkunam, Louis S. Constine, Hans Theodor Eich, Andrew Wirth, Richard T. Hoppe
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.