This article is more than 5 years old. Information may no longer be current.
Involved-field radiotherapy represents best treatment for low-risk Hodgkin's lymphoma
Involved-field radiotherapy should be considered the standard of care for patients with stage 1A nodular lymphocyte-predominant Hodgkin’s lymphoma, according to a report from the German Hodgkin Study Group.
Additionally, rituximab (Rituxan; Genentech, Biogen Idec) monotherapy resulted in an increased risk for relapse in this patient population.
“Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL) is a rare entity, accounting for approximately 5% of all Hodgkin’s lymphomas,” Andreas Engert, MD, chairman of the German Hodgkin Study Group and professor of internal medicine, hematology and oncology at University Hospital Cologne, and colleagues wrote. “Given a mostly indolent clinical course, limited-stage NLPHL is often treated with less aggressive approaches than classical Hodgkin's lymphoma. … However, this recommendation is based on data from registries as well as retrospective analyses from single institutions and clinical studies with a rather short follow-up.”
The German Hodgkin Study Group conducted this study to determine the standard of care for patients with early-stage NLPHL. They observed the long-term outcomes of 256 patients (median age at diagnosis, 39 years; 76% men) enrolled in German Hodgkin Study Group clinical trial protocols between 1998 and 2009.
Treatment modalities studied included combined-modality treatment (CMT; n = 72), extended-field radiotherapy (EF-RT; n = 49), involved-field radiotherapy (IF-RT; n = 108) and four weekly standard doses of rituximab (n = 27).
Median follow-up for the entire patient group was 91 months (CMT = 95 months; EF-RT = 110 months; IF-RT = 87 months; rituximab = 49 months).
Engert and colleagues observed nearly equivalent tumor control for CMT, EF-RT and IF-RT. They reported 8-year PFS rates of 88.9% (95% CI, 84.5-93.4) for the entire patient population; 91.9% (95% CI, 86.5-97.3) among those treated with IF-RT; 88.5% (95% CI, 80.3-96.8) among those treated with CMT; and 88.4% (73.6-95) among those treated with EF-RT.
Engert and colleagues reported 8-year OS rates of 98.2% (95% CI, 96.4-100) for the entire patient population; 99% (95% CI, 97.2-100) for those treated with IF-RT; 98.6% (95% CI, 95.9-100) for those treated with CMT; and 95.7% (95% CI, 89.9-100) for those treated with EF-RT.
Although patients treated with rituximab achieved a 4-year OS rate of 100%, they experienced a median 4-year PFS of 81% (95% CI, 66-96), suggesting a significantly higher risk for relapse than other treatment modalities.
Seventeen patients (6.6%) developed a second malignancy during follow-up. Nine developed secondary solid tumors, seven developed non-Hodgkin’s lymphoma and one developed chronic myeloid leukemia.
Eight patients treated with CMT developed a second malignancy, compared with three patients treated with EF-RT and four patients treated with IF-RT.
Twelve deaths occurred during follow-up; however, only one death was attributed to NLPHL. Other causes of death included cardiovascular disease (n = 3), respiratory disease (n = 2), second malignancies (n = 2) and suicide (n = 1).
“IF-RT at 30 Gy should be the preferred treatment for patients with stage 1A NLPHL presenting without clinical risk factors,” Engert and colleagues concluded. “This is based on the similar efficacy of IF-RT compared with CMT and EF-RT, the reduced acute toxicity, and the potentially reduced risk for the development of late effects such as second malignancies.
“Rituximab alone should not be routinely used in patients with stage 1A NLPHL because of the increased frequency of relapses occurred,” the researchers wrote. “The question of whether treatment intensity can be further reduced in low-risk patients with stage 1A NLPHL, while patients who are at higher risk for relapse receive more intensive approaches such as a combination of chemotherapy and an anti-CD20 antibody, should be subject to further studies.” – by Cameron Kelsall
Disclosure: Engert reports research funding and honoraria from, travel expenses from and a consultant role with Takeda/Millennium. Please see the full study for a list of all other researchers’ relevant financial disclosures.