The effectiveness of chemotherapy and radiotherapy in nodular lymphocyte predominant Hodgkin lymphoma depending on disease stage

This study aimed to investigate the effectiveness of chemotherapy and radiotherapy (CRT) in patients with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). 

This study concluded that combined CRT may be more effective in patients with early-stage NLPHL, particularly in older patients. 

NLPHL is an uncommon type of Hodgkin lymphoma (HL). It accounts for less than 10% of all HL cases. Most people with NLPHL have early-stage lymphoma (stage 1 or 2) when diagnosed. The lymphoma is in one place or a few places close together. Some people are diagnosed with advanced-stage lymphoma (stage 3 or 4). This means the NLPHL is more widespread.  

Treatments for NLPHL are not very well established, as the occurrence of this condition is rather rare. Radiotherapy (RT), chemotherapy (CT), and combined RT and CT (CRT) can be used to treat patients with NLPHL. The effectiveness of each of these therapies according to stages in patients with NLPHL has not been well described. 

This study involved 1281 patients with NLPHL, overall. Patients were treated with RT alone, CT alone, or CRT. These patients were compared to a group of patients who did not have RT nor CT (control group).

For patients with early-stage disease, CRT was associated with the best survival. The mean overall survival (OS) improved by 20 months and the risk of death was reduced by more than 80% with CRT. RT also improved OS by 15 months in patients with early-stage disease. The risk of death was reduced by 60-80% with RT alone. CT alone did not have significant benefits in OS in patients with early-stage NLPHL.  

In patients with early-stage disease, CRT was associated with significant survival benefits in patients aged 45 and older. For these patients, OS was improved by 43.8 months. 

For patients with advanced-stage disease, RT, CT, or CRT did not have a significant effect on survival with less than 36 months follow-up. However, there was a tendency of increasing survival benefit with CT alone and CRT beyond 36 months of follow-up. 

This study concluded that CRT may be more effective in older patients with early-stage NLPHL. 

This study was based on information from a database. Patients were not randomly assigned to the groups. Further studies are needed to identify effective treatments in patients with advanced-stage NLPHL.