Outcomes for NLPHL patients in daily clinical practice

This study reviewed the medical records of patients with nodular lymphocytic predominant Hodgkin's lymphoma (NLPHL) to evaluate their outcomes. This study concluded that all patients had excellent outcomes, even with a wide range of therapies.

Nodular lymphocytic predominant Hodgkin's lymphoma (NLPHL) is an uncommon type of Hodgkin’s lymphoma (HL), affecting only 5% of new HL patients. 75% of NLPHL patients have stage 1 or stage 2 disease. A variety of therapy approaches are used to treat these patients. These range from watchful waiting to combined chemoimmunotherapy, such as R-ABVD (rituximab combined with doxorubicin, bleomycin, vinblastine, dacarbazine).

Outcomes are generally favorable for NLPHL, with an overall survival (time from treatment until death from any cause) rate at 5 years of 83%. Relapsed patients can be successfully treated with rituximab (Rituxan) alone or chemoimmunotherapy. All outcomes for NLPHL patients remain under investigation.

This study involved 43 NLPHL patients with stage 1 – 2 (60.5%) and stage 3 – 4 (39.5%) disease. Front-line treatments included ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy, R-CHOP (rituximab combined with cyclophosphamide, doxorubicin, vincristine, prednisone), radiation, or rituximab (Rituxan) alone. Second-line treatments included DHAP (dexamethasone, high-dose cytarabine or Ara-C, cisplatin), ICE (ifosfamide, carboplatin, etoposide), or R-ABVD. All patients received front-line treatment. Only 36% of patients needed second-line treatment. Patients were followed for an average of 46 months.

90.7% of patients showed a complete response (complete disappearance of all signs of cancer). 4.7% of patients showed a partial response (tumor shrinkage). The average progression-free survival (PFS; from date of diagnosis to the date of progression, relapse, or death) rate was 94.51 months. This study did not determine overall survival (OS; from date of diagnosis to the date of death from any cause).

At 12 months, 36% of patients experienced relapse or disease progression. Of these, 85.7% had advanced disease and only 14.3% (1 patient) had early stage disease. 71.4% received second-line chemotherapy (DHAP or ICE). 28.6% received second-line chemoimmunotherapy (R-ABVD). After second-line treatment, all of these patients showed a complete response.

This study concluded that all patients had excellent outcomes, even with a wide range of therapies. The authors also suggest that immunotherapy may be reserved for further relapses.

This study looked back in time to analyze data. As a result, the collected data may be incomplete. Also, the small number of patients in this study limits the conclusions that can be drawn from the results. More studies are needed to further confirm these results in larger patient populations.