Advertisement

Encouraging activity for R-CHOP in advanced stage nodular lymphocyte–predominant Hodgkin lymphoma

Michelle A. Fanale, Chan Yoon Cheah, Amy Rich, L. Jeffrey Medeiros, Chao-Ming Lai, Yasuhiro Oki, Jorge E. Romaguera, Luis E. Fayad, F. B. Hagemeister, Felipe Samaniego, Maria A. Rodriguez, Sattva S. Neelapu, Hun J. Lee, Loretta Nastoupil, Nathan H. Fowler, Francesco Turturro, Jason R. Westin, Michael L. Wang, Peter McLaughlin, Chelsea C. Pinnix, Sarah A. Milgrom, Bouthaina Dabaja, Sandra B. Horowitz and Anas Younes

Key Points

  • R-CHOP results in excellent response rates and durable remissions in NLPHL.

Publisher's Note: There is an Inside Blood Commentary on this article in this issue.

Abstract

Nodular lymphocyte Hodgkin lymphoma (NLPHL) is a rare disease for which the optimal therapy is unknown. We hypothesized that rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) could decrease rates of relapse and transformation. We retrospectively reviewed patients with NLPHL diagnosed between 1995 and 2015 confirmed by central pathologic review. Fifty-nine had sufficient treatment and follow-up data for analysis. We described progression-free survival (PFS), overall survival (OS), and histologic transformation according to treatment strategy and explored prognostic factors for PFS and OS. The median age at diagnosis was 41 years; 75% were male, and 61% had a typical growth pattern. Twenty-seven patients were treated with R-CHOP with an overall response rate of 100% (complete responses 89%). The median follow-up was 6.7 years, and the estimated 5- and 10-year PFS rates for patients treated with R-CHOP were 88.5% (95% confidence interval [CI], 68.4% to 96.1%) and 59.3 (95% CI, 25.3% to 89.1%), respectively. Excluding patients with histologic transformation at diagnosis, the 5-year cumulative incidence of histologic transformation was 2% (95% CI, 87% to 100%). No patient treated with R-CHOP experienced transformation. A high-risk score from the German Hodgkin Study Group was adversely prognostic for OS (P = .036), whereas male sex and splenic involvement were adversely prognostic for PFS (P = .006 and .002, respectively) but not OS. Our data support a potential role for R-CHOP in patients with NLPHL. Larger prospective trials are needed to define the optimal chemotherapy regimen.

  • Submitted February 14, 2017.
  • Accepted April 30, 2017.
View Full Text