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Treating limited stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome

Kerry J. Savage, Brian Skinnider, Mubarak Al-Mansour, Laurie H. Sehn, Randy D. Gascoyne and Joseph M. Connors

Abstract

The appropriate therapy for limited stage nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is unclear. In contrast to classical Hodgkin lymphoma (CHL), chemotherapy is often omitted; however, it is unknown whether this impacts the risk of relapse. Herein, we compared the outcome of patients with limited stage NLPHL treated in an era in which ABVD chemotherapy was routinely incorporated into the primary therapy to an earlier era in which radiotherapy (RT) was used as a single modality. Using the BCCA Lymphoid Cancer Database 88 patients with limited stage NLPHL (stage 1A/1B or 2A, non-bulky disease < 10 cm) were identified. Patients were treated following era-specific guidelines: Before 1993 (n=32) RT alone; 1993-present (n=56) ABVD-like chemotherapy for 2 cycles followed by RT with the exception of 14 patients who received ABVD chemotherapy alone. Most patients were male (75%) with stage 1 disease (61%). In an era to era comparison, the 10 year TTP (98% vs 76% p=0.0074), PFS (91% vs 65% p=0.0024) and OS (93% vs 84%, p=0.074) favored the ABVD treatment era compared to the RT alone era. Treating limited stage NLPHL similarly to CHL may improve outcome compared to the use of radiation alone.

  • Submitted July 8, 2011.
  • Accepted August 17, 2011.