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Rare Hodgkin lymphoma subtype has good prognosis after relapse
Salvage approaches led to favorable prognosis among patients with relapsed or refractory nodular lymphocyte-predominant Hodgkin lymphoma, according to study findings.
“Factors such as time to disease recurrence and previous treatment may guide the choice of the optimal salvage approach for the individual patient,” Dennis A. Eichenauer, MD, from the first department of internal medicine at University Hospital Cologne, Germany, and colleagues wrote.
Five percent of all cases of Hodgkin lymphoma are nodular lymphocyte predominant. Although often diagnosed early, late relapse is common.
Ideal treatment strategies for patients with relapsed or refractory nodular lymphocyte-predominant Hodgkin lymphoma have remained unclear.
Eichenauer and colleagues sought to evaluate current treatments and define the clinical course of patients with relapsed or refractory nodular lymphocyte-predominant Hodgkin lymphoma. Investigators also explored whether specific patient characteristics influenced second-line treatment.
Using data from 12 studies within the German Hodgkin Study Group, researchers evaluated outcomes of 99 patients (median age at diagnosis, 40 years; 76% men) who received first-line treatment and subsequently developed disease recurrence (n = 91) or primary disease progression (n = 8).
Sixty-two percent of patients had early-stage disease, of whom 33% received first-line treatment with radiotherapy alone, 57% received chemotherapy with or without radiotherapy, and 10% received anti-CD20 antibody treatment with rituximab (Rituxan; Genentech, Biogen).
Fourteen percent of patients had intermediate disease and 24% had advanced disease, all of whom received chemotherapy with or without radiotherapy as first-line treatment.
Median follow-up from initial diagnosis was 11.2 years. Median time to disease recurrence was 3.7 years (range, 0.2-19.4). Relapse occurred more than 5 years after initial diagnosis among 39% of patients.
Second-line treatments included single-agent anti-CD20 antibody therapy or radiotherapy alone (37%), conventional chemotherapy with or without anti-CD20 antibody therapy and with or without radiotherapy (27%), and high-dose chemotherapy followed by autologous stem cell transplantation (31%). Four patients did not receive any salvage therapy.
The overall 3-year PFS after recurrence was 80.9% (95% CI, 72.5-89.4) and 5-year PFS was 75.6% (95% CI, 65.7-85.5). Five-year OS rate after recurrence was 89.5%.
Researchers did not observe significant differences in PFS based on second-line treatment options.
Among patients who received single-agent anti-CD20 antibody treatment or radiotherapy alone, PFS was 74.1% and OS was 97.2%.
Among patients who received conventional chemotherapy with or without anti-CD20 antibody treatment with or without radiotherapy, 5-year PFS was 68% and OS was 77.8%.
Among patients who received high-dose chemotherapy and autologous stem cell transplant, 5-year PFS was 84.6% and OS was 89.8%.
Survival among 26 patients with primary disease progression or relapse within 1 year after diagnosis appeared significantly worse compared with 73 patients who developed recurrence later (5-year OS, 65.4% vs. 94.9%; P = .0029).
Researchers acknowledged the small size of treatment groups, lack of expert review and missing information on disease stage at relapse for patients, as limitations.
“Nonetheless, the analysis provides evidence that individuals with relapsed or refractory NLPHL have a generally favorable prognosis,” the researchers wrote.
“The most appropriate salvage therapy for the individual patient should be chosen on the basis of factors such as the time interval between the initial nodular lymphocyte-predominant Hodgkin lymphoma diagnosis and disease recurrence, previous treatment and age at relapse or primary disease progression,” they added. – by Melinda Stevens
Disclosures: The authors report no relevant financial disclosures.