Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of lymphoma that, like other Hodgkin lymphomas, has historically been treated aggressively. However, in most cases, NLPHL has an indolent course, which raises the question to what extent these patients require aggressive upfront treatment. We describe the management and outcomes of consecutive NLPHL patients diagnosed at Memorial Sloan Kettering Cancer Center (MSK), with a focus on evaluating active surveillance. All patients aged 16 years or older diagnosed and followed at MSK between 1974 and 2016 were included. Treatment outcomes were compared between management with active surveillance and other strategies. We identified 163 consecutive patients who were treated with radiotherapy alone (46%), active surveillance (23%), chemotherapy (16%), combined modality (12%), or rituximab monotherapy (4%). Median follow-up was 69 months. Five-year progression-free survival (PFS), second progression-free survival (PFS2), and overall survival (OS) estimates were 85% (95% CI, 78%-90%), 97% (95% CI, 92%-99%), and 99% (95% CI, 95%-100%), respectively. Only one of seven deaths was lymphoma related. Patients managed with active surveillance had slightly shorter PFS than those receiving any active treatment, with 5-year PFS of 77% (95% CI, 56%-89%) vs 87% (95% CI, 79%-92%), P = .017. This difference did not translate into better PFS2 or OS. Only 10 patients managed with active surveillance (27%) eventually required treatment, after a median of 61 months, and none died. NLPHL has an excellent prognosis. Within the limitations of a retrospective analysis, active surveillance is a viable initial management strategy for selected NLPHL patients.
The publication of this article follows another paper by Else Kröner Forschungskolleg Cologne fellow Sven Borchmann and principal investigator Andreas Engert examining osteonecrosis as a previously underappreciated side effect of contemporary Hodgkin lymphoma treatment, published in the February 2019 edition of Leukemia.
Borchmann, S., Joffe, E., Moskowitz, C. H., Zelenetz, A. D., Noy, A., Portlock, C. S., Gerecitano, J. F., Batlevi, C. L., Caron, P. C., Drullinsky, P., Hamilton, A., Hamlin, P. A., Horwitz, S. M., Kumar, A., Matasar, M. J., Moskowitz, A. J., Owens, C. N., Palomba, M. L., Younes, A., & Straus, D. J. (2019). Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma. Blood, blood-2018-10-877761. Accessed March 04, 2019. doi.org/10.1182/blood-2018-10-877761.
Borchmann S, Müller H, Haverkamp H, Baues C, Marková J, Hüttmann A, Glunz A, Fuchs M, Borchmann P, Engert A. Symptomatic osteonecrosis as a treatment complication in Hodgkin lymphoma: an analysis of the German Hodgkin Study Group (GHSG).Leukemia. 2019 Feb;33(2):439-446. doi: 10.1038/s41375-018-0240-8. Epub 2018 Aug 21.