Patients with certain HL at risk for transformation to aggressive lymphoma years later

The risk for transformation to aggressive lymphoma, commonly diffuse large B-cell lymphoma, was substantial in patients with nodular lymphocyte-predominant Hodgkin’s lymphoma and may occur decades after the original diagnosis.

According to background information in the study, patients with nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL) have an inherent tendency to develop secondary non-Hodgkin’s lymphomas. To assess this association at long-term follow-up, researchers searched the British Columbia Cancer Agency Lymphoid Cancer Database and identified 95 patients with NLPHL between 1965 and 2006.

Median age at diagnosis was 37 years. The median follow-up time for living patients was 6.5 years, and the median time to disease transformation was 8.1 years. Fourteen percent of patients experienced transformation to aggressive lymphoma. The median age at the time of transformation was 42 years.

The actuarial risk for transformation was 5% at five years, 7% at 10 years, 15% at 15 years, 31% at 20 years and 36% at 25 years. Also, there was no definitive plateau, according to the researchers.

In multivariate analysis, splenic involvement was the only predictor of future transformation to aggressive lymphoma with a HR of 4.18 (P=.006). The 10-year PFS rate was 52% and the OS rate was 62%.

“Long-term surveillance and repeat biopsy at the time of relapse are imperative in this patient population to ensure that the appropriate therapy is delivered,” researchers said.

Al-Mansour M. J Clin Oncol. 2010;doi:10.1200/JCO.2009.24.9516.