Optimal treatment for relapsed and unresponsive nodular lymphocyte-predominant Hodgkin lymphoma

This study aimed to investigate treatments and outcomes for patients with relapsed or unresponsive nodular lymphocyte-predominant Hodgkin lymphoma.

This study concluded that these patients have a good overall prognosis and treatments should be chosen individually.

Radiotherapy (RT), chemotherapy (CT) and rituximab (Rituxan) are common treatments for nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). When these fail to work, relapsed or unresponsive disease occurs. Salvage therapies are those given to treat relapsed/unresponsive disease.  

It is important to evaluate what the optimal treatment for patients with relapsed or unresponsive NLPHL is. 

This study involved data from 99 patients who had relapsed or unresponsive NLPHL and had received first-line treatment. 91 of these patients developed disease recurrence and 8 patients had primary disease progression. 20% of patients received RT alone as first-line treatment. 74% received CT with or without RT. 6% received single-agent anti-CD20 antibody treatment. Patients were followed for an average of 11.2 years.

The average time to disease recurrence was 3.7 years. 37% of patients received single-agent anti-CD20 antibody treatment or RT alone as salvage therapy. 27% of patients received conventional CT with or without rituximab, with or without RT. 31% received high-dose CT followed by autologous stem cell transplantation (ASCT). 4% of patients received no salvage treatment.

The 5-year progression-free survival (PFS; patients alive 5 years later without cancer worsening) rate was 75.6%. The 5-year PFS was 74.1% after single-agent anti-CD20 antibody treatment or RT alone. The 5-year PFS was 68% after conventional CT with or without anti-CD20 antibody treatment, with or without RT. The 5-year PFS was 84.6% after high dose CT and ASCT.

The 5-year overall survival (OS; patients alive 5 years later) rate was 89.5%. The 5-year OS rate was 97.2% after single-agent anti-CD20 antibody treatment or RT alone. The 5-year OS rate was 77.8% after conventional CT with or without anti-CD20 antibody treatment, with or without RT. The 5-year OS rate was 89.8% after high dose CT and ASCT.

This study concluded that patients with relapsed or unresponsive NLPHL had a good overall prognosis and treatments should be chosen individually.

This study included a small number of patients from a German database. Larger studies should be carried out on more different populations.