Nodular lymphocyte predominant Hodgkin lymphoma behaves as a distinct clinical entity with good outcome: evidence from 14-year follow-up in the West of Scotland Cancer Network

Abstract

Clinically and biologically, nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) has much more in common with germinal-center derived B-cell non-Hodgkin lymphoma (NHL) than with classical Hodgkin lymphoma (cHL). Management of NLPHL remains controversial. In a 14-year multicenter series, 69 cases were analyzed, and the median follow-up was 53 months (range 11–165.) B-symptoms were present in only 4.3% of patients, and 81.1% of patients had stage I/II disease. Treatment was with radiotherapy (53.6%), chemotherapy (21.7%), combined modality (17.4%), and observation (7.2%). In all, 10.1% of patients relapsed and 2.9% of patients developed high-grade transformation to DLBCL. All relapses and transformations were salvageable. No patient died of their disease. The 5-year relapse-free survival was 92%, transformation-free survival 98.4%, and overall survival 100%. We conclude that NLPHL behaves as a distinct clinical entity, often presenting at an early stage without risk factors. It has an excellent outcome. It may be possible, in early-stage disease, to reduce the intensity of therapy in NLPHL, to single-modality radiotherapy, without affecting OS.

Keywords::

• Nodular lymphocyte-predominant Hodgkin lymphoma
• chemotherapy
• radiotherapy
• outcome studies
• cohort studies

Acknowledgements

We would like to acknowledge the support of the following colleagues in the West of Scotland who provided data: Dr. H. Beshti, Dr. A. Broom, Dr. P. Clarke, Dr. F. Cutler, Dr. J. Gillies, Dr. W. Gordon, Dr. M. Hughes, Dr. A. Hung, Dr. R. Jackson, Dr. V. Lynch, Dr. L. Mitchell, Dr. R. Neilson, Dr. P. Paterson, Dr. G. Rainey, Dr. A. Sefcick, Dr. R. Thomas. We thank Mrs. Heather Wotherspoon (Haemato-oncology Network Manager, West of Scotland Cancer Network) for access to the WoSCAN lymphoma database.

K.F. is funded by a Kay Kendall Leukaemia Fund Clinical Research Fellowship

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