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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 Fayad, F. B. Hagemeister, Felipe Samaniego, Maria A. Rodriguez, Sattva S. Neelapu, Hun J. Lee, Loretta Nastoupil, Nathan Fowler, Francesco Turturro, Jason Westin, Michael Wang, Peter McLaughlin, Chelsea Pinnix, Sarah Milgrom, Bouthaina Dabaja, Sandra B. Horowitz and Anas Younes

Key points

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

Abstract

Nodular lymphocyte Hodgkin lymphoma (NLPHL) is a rare disease for which the optimal therapy is unknown. We hypothesized 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 (PFS), overall survival (OS) and histologic transformation according to treatment strategy and explorede prognostic factors for PFS and OS. The median age at diagnosis was 41, 75% were male and 61% had a typical growth pattern. 27 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% CI 68.4-96.1%) and 59.3 (95% CI 25.3 to 89.1%), respectively. The estimated 5- and 10-year PFS for patients treated with R-CHOP was 88.5% (95% CI 68.4-96.1%) 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 87-100%). No patient treated with R-CHOP experienced transformation. A high German Hodgkin Study Group risk score was adversely prognostic for OS (p=0.036), while male gender and splenic involvement were adversely prognostic for PFS (respectively p= 0.006 and 0.002) 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.