Is active surveillance effective in managing NLPHL?

This study evaluated the outcomes of active surveillance versus upfront treatment for patients with nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL). It was found that active surveillance is effective for managing NLPHL.

NLPHL is a rare subtype of non-Hodgkin's lymphoma. It may be treated with intensive anti-cancer drugs. However, because NLPHL often grows slowly, patients may not experience severe symptoms. This means that intensive therapies may not be immediately needed. This can help avoid long-term side effects.

Active surveillance is a strategy of observing cancer so that patients are treated only when necessary. For patients with indolent (painless) NLPHL or a low tumor burden, this strategy may be helpful. Whether active surveillance is more effective than immediate treatment for managing NLPHL remains unclear.

This study included 163 patients who were recently diagnosed with NLPHL. 23% of patients were under active surveillance. 46% received radiation therapy only. 28% received chemotherapy only. Patients were followed-up for an average of 69 months.

At follow-up, 37 patients had cancer progression (tumor growth or spread) or recurrence. 27% of patients (10 patients) under active surveillance had progression.

For all patients, 5-year overall survival (patients still alive 5 years later) was 99%. 5-year progression-free survival (patients still alive 5 years later without cancer progression; PFS) was 85%.

At an average of 7 years after diagnosis, 12 patients developed a more aggressive form of cancer (transformation). At an average of 7.8 years after diagnosis, 12 patients developed a second cancer.

Active surveillance was significantly associated with a shorter 5-year PFS compared to receiving treatment (77% vs. 87%). 76% of patients under active surveillance for over 5 years never required treatment.

This study concluded that active surveillance may be an effective strategy for managing newly-diagnosed NLPHL.

This study included patients from only one center, so the results may not be applicable to patients elsewhere. This study was retrospective. This means it looked back in time to analyze data. Also, this study was small. More studies are needed to confirm these results.

If you have been recently diagnosed with NLPHL, talk to your care team about active surveillance.