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Eichenauer DA, Fuchs M. Treatment of Nodular Lymphocyte-Predominant Hodgkin Lymphoma: Where Do We Stand? Where Do We Go? Cancers (Basel) 2023; 15:3310. [PMID: 37444420 DOI: 10.3390/cancers15133310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare B cell-derived lymphoma entity accounting for ≈5% of all Hodgkin lymphoma (HL) cases. In recent decades, patients with newly diagnosed NLPHL have usually been treated very similarly to classical HL (cHL). The 10-year overall survival rates with HL-directed approaches are in excess of 90%. However, pathological and clinical characteristics of NLPHL resemble indolent B-cell non-Hodgkin lymphoma (B-NHL) in some aspects. Thus, nodular lymphocyte-predominant B-cell lymphoma has been proposed as an alternative name, and the use of B-NHL-directed treatment strategies has become more common in NLPHL despite limited data. Given the often indolent clinical course of NLPHL, even in the case of relapse, the majority of patients with disease recurrence do not require high-dose chemotherapy and autologous stem cell transplantation but are treated sufficiently with low-intensity approaches such as single-agent anti-CD20 antibody treatment. The establishment of novel prognostic scores for NLPHL patients may optimize risk group and treatment allocation in newly diagnosed and relapsed disease.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, D-50937 Cologne, Germany
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, D-50937 Cologne, Germany
| | - Michael Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, D-50937 Cologne, Germany
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, D-50937 Cologne, Germany
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2
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Xavier AC, Suzuki R, Attarbaschi A. Diagnosis and management of rare paediatric Non-Hodgkin lymphoma. Best Pract Res Clin Haematol 2023; 36:101440. [PMID: 36907633 DOI: 10.1016/j.beha.2023.101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/16/2023]
Abstract
Mature B-cell lymphomas, (B- or T-cell) lymphoblastic lymphomas (LBL), and anaplastic large cell lymphoma (ALCL) correspond to about 90% of all non-Hodgkin lymphoma (NHL) cases occurring in children and adolescents. The remaining 10% encompass a complex group of entities characterized by low/very low incidences, paucity of knowledge in terms of underlying biology in comparison to their adult counterparts, and consequent lack of standardization of care, information on clinical therapeutic efficacy and long-term survival. At the Seventh International Symposium on Childhood, Adolescent and Young Adult NHL, organized on October 20-23, 2022, in New York City, New York, US, we had the opportunity to discuss clinical, pathogenetic, diagnostic, and treatment aspects of certain subtypes of rare B- or T-cell NHL and they will be the topic of this review.
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Affiliation(s)
- Ana C Xavier
- Division of Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder 512 Birmingham, AL, 35233, USA.
| | - Ritsuro Suzuki
- Department of Hematology and Oncology, Shimane University, 89-1 En-ya Cho, Izumo, 693-8501, Japan.
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Kinderspitalgasse 6, 1090, Vienna, Austria; St. Anna Children's Cancer Research Institute, Zimmermannplatz 10, 1090, Vienna, Austria.
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3
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Zijtregtop EAM, Winterswijk LA, Beishuizen TPA, Zwaan CM, Nievelstein RAJ, Meyer-Wentrup FAG, Beishuizen A. Machine Learning Logistic Regression Model for Early Decision Making in Referral of Children with Cervical Lymphadenopathy Suspected of Lymphoma. Cancers (Basel) 2023; 15:cancers15041178. [PMID: 36831520 PMCID: PMC9954739 DOI: 10.3390/cancers15041178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
While cervical lymphadenopathy is common in children, a decision model for detecting high-grade lymphoma is lacking. Previously reported individual lymphoma-predicting factors and multivariate models were not sufficiently discriminative for clinical application. To develop a diagnostic scoring tool, we collected data from all children with cervical lymphadenopathy referred to our national pediatric oncology center within 30 months (n = 182). Thirty-nine putative lymphoma-predictive factors were investigated. The outcome groups were classical Hodgkin lymphoma (cHL), nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), non-Hodgkin lymphoma (NHL), other malignancies, and a benign group. We integrated the best univariate predicting factors into a multivariate, machine learning model. Logistic regression allocated each variable a weighing factor. The model was tested in a different patient cohort (n = 60). We report a 12-factor diagnostic model with a sensitivity of 95% (95% CI 89-98%) and a specificity of 88% (95% CI 77-94%) for detecting cHL and NHL. Our 12-factor diagnostic scoring model is highly sensitive and specific in detecting high-grade lymphomas in children with cervical lymphadenopathy. It may enable fast referral to a pediatric oncologist in patients with high-grade lymphoma and may reduce the number of referrals and unnecessary invasive procedures in children with benign lymphadenopathy.
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Affiliation(s)
- Eline A. M. Zijtregtop
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Louise A. Winterswijk
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Tammo P. A. Beishuizen
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
| | - Christian M. Zwaan
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Rutger A. J. Nievelstein
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Division Imaging & Oncology, Department of Radiology & Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Friederike A. G. Meyer-Wentrup
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
| | - Auke Beishuizen
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-88-9727272
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4
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Abstract
The nitrogen mustards are powerful cytotoxic and lymphoablative agents and have been used for more than 60 years. They are employed in the treatment of cancers, sarcomas, and hematologic malignancies. Cyclophosphamide, the most versatile of the nitrogen mustards, also has a place in stem cell transplantation and the therapy of autoimmune diseases. Adverse effects caused by the nitrogen mustards on the central nervous system, kidney, heart, bladder, and gonads remain important issues. Advances in analytical techniques have facilitated the investigation of the pharmacokinetics of the nitrogen mustards, especially the oxazaphosphorines, which are prodrugs requiring metabolic activation. Enzymes involved in the metabolism of cyclophosphamide and ifosfamide are very polymorphic, but a greater understanding of the pharmacogenomic influences on their activity has not yet translated into a personalized medicine approach. In addition to damaging DNA, the nitrogen mustards can act through other mechanisms, such as antiangiogenesis and immunomodulation. The immunomodulatory properties of cyclophosphamide are an area of current exploration. In particular, cyclophosphamide decreases the number and activity of regulatory T cells, and the interaction between cyclophosphamide and the intestinal microbiome is now recognized as an important factor. New derivatives of the nitrogen mustards continue to be assessed. Oxazaphosphorine analogs have been synthesized in attempts to both improve efficacy and reduce toxicity, with varying degrees of success. Combinations of the nitrogen mustards with monoclonal antibodies and small-molecule targeted agents are being evaluated. SIGNIFICANCE STATEMENT: The nitrogen mustards are important, well-established therapeutic agents that are used to treat a variety of diseases. Their role is continuing to evolve.
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Affiliation(s)
- Martin S Highley
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Bart Landuyt
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Hans Prenen
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Peter G Harper
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Ernst A De Bruijn
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
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5
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Shankar A, Hall GW, McKay P, Gallop-Evans E, Fielding P, Collins GP. Management of children and adults with all stages of nodular lymphocyte predominant Hodgkin lymphoma - All StAGEs: A consensus-based position paper from the Hodgkin lymphoma subgroup of the UK National Cancer Research Institute. Br J Haematol 2022; 197:679-690. [PMID: 35362554 DOI: 10.1111/bjh.18169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 12/31/2022]
Abstract
A consensus statement for the management for patients of all ages with all stages of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) - All StAGEs - is proposed by representatives of the UK National Cancer Research Institute (NCRI) Hodgkin lymphoma study group and the Children's Cancer & Leukaemia Group. Based on current practices and published evidence, a consensus has been reached regarding diagnosis, staging and risk-ik7 stratified management which includes active surveillance, low- and standard-dose immunochemotherapy and radiotherapy.
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Affiliation(s)
- Ananth Shankar
- Children and Young People's Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgina W Hall
- Paediatric & Adolescent Haematology/Oncology unit, Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pam McKay
- Department of Haematology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Eve Gallop-Evans
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Patrick Fielding
- Wales Research and Diagnostic PET Imaging Centre, Department of Radiology, Cardiff, UK
| | - Graham P Collins
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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6
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Klekawka T, Balwierz W, Brozyna A, Chaber R, Dadela-Urbanek A, Koltan A, Kwasnicka J, Mitura-Lesiuk M, Muszynska-Roslan K, Przybyszewski B, Ruranska I, Smalisz K, Mizia-Malarz A, Stachowicz-Stencel T, Stolarska M, Wziatek A, Zielezinska K, Skoczen S. Nodular lymphocyte predominant Hodgkin lymphoma: Experience of Polish Pediatric Leukemia/Lymphoma Study Group. Pediatr Hematol Oncol 2021; 38:609-619. [PMID: 33734010 DOI: 10.1080/08880018.2021.1894278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) is a rare clinical entity. To investigate NLPHL clinical course and treatment a survey was performed within Polish Pediatric Leukaemia/Lymphoma Study Group (PPLLSG) participating centers. A questionnaire was sent to all participating centers and analysis of clinical data was performed. From 2010 to 2019, 19 pediatric patients with confirmed NLPHL were registered in Poland. Median age of patients was 12.2 (5.5 - 17.8) years. NLPHL occurred mainly in males (n = 17). Most of the patients (n = 16) had early stage disease - Stage I (n = 6) and stage II (n = 10). Four of the six patients with stage I disease (I A, n = 5; I B, n = 1) underwent complete primary resection. One of these relapsed and was treated with CVP (cyclophosphamide, vinblastine, prednisone) chemotherapy. Two other patients who were not resected completely received CVP chemotherapy and no relapses were observed. Thirteen patients presented with unresectable disease. Of these, eight received three CVP chemotherapy cycles, and five were treated with other chemotherapy regimens. Three relapses were observed and these patients were further treated with chemotherapy and rituximab. One patient underwent autologous stem cell transplantation (auto-SCT). All patients remain alive. Five-year progression-free survival and overall survival for the entire group of patients was 81.6% and 100%, respectively. NLPHL treatment results are consistent with results noted in other countries. Early stage patients have very good outcomes with surgery and observation or low intensity chemotherapy, but this approach may be insufficient in advanced disease.
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Affiliation(s)
- Tomasz Klekawka
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Brozyna
- Department of Pediatric Oncology, Children's Memorial Health Institute, Warsaw, Poland
| | - Radoslaw Chaber
- Department of Pediatrics, Institute of Medical Sciences, Medical College, University of Rzeszow, Rzeszow, Poland
| | | | - Andrzej Koltan
- Department of Pediatric Oncology and Hematology Nicolaus Copernicus, University Collegium Medicum, Bydgoszcz, Poland
| | - Justyna Kwasnicka
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Borys Przybyszewski
- Pediatric Oncology and Hematology Department, Regional Specialized Children's Hospital, Olsztyn, Poland
| | - Iwona Ruranska
- Department of Pediatric Hematology and Oncology, Silesian Academy of Medicine, Zabrze, Poland
| | - Katarzyna Smalisz
- Department of Pediatrics, Hematology and Oncology, Warsaw Medical University, Warsaw, Poland
| | - Agnieszka Mizia-Malarz
- Oncology, Hematology and Chemotherapy Unit, Pediatric Department Medical, University of Silesia, Katowice, Poland
| | | | | | - Agnieszka Wziatek
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Katarzyna Zielezinska
- Department of Pediatrics, Oncology and Hematology, Pomeranian Medical University of Szczecin, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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7
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Núñez-García B, Rodríguez-Pertierra M, Sequero S, Carvajal LG, Ruano-Ravina A, Aguiar D, Gumá J, Blanco CQ, García Arroyo FR, Garitaonaindia Y, Provencio Z, Calvo V, González-San Segundo C, Provencio M. Long-term follow-up of patients with nodular lymphocyte predominant Hodgkin lymphoma: A report from the Spanish Lymphoma Oncology Group. Hematol Oncol 2021; 39:506-512. [PMID: 33528063 DOI: 10.1002/hon.2835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/21/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022]
Abstract
Nodular lymphocytic predominance Hodgkin lymphoma (NLPHL) is a very uncommon subtype of Hodgkin lymphoma (HL), representing approximately 5% of all HL cases, with an incidence of 0.3/100,000 cases per year and with unique characteristics which distinguish it from classic Hodgkin lymphoma. Given its low frequency, there is a lack of prospective randomized studies to inform practice, the accumulated experience of academic groups being the main source of relevant information for the management of these patients. Eighty-five patients recruited by the Spanish Lymphoma Group (GOTEL) from 12 different hospitals were retrospectively analyzed to describe their sociodemographic and clinical characteristics. The median follow-up was 16 years, with a 10-year overall survive of 92.9% and 81.2% at 20 years. Five patients developed a second malignancy. No transformation to a more aggressive lymphoma was detected. A total of 31% tumor relapses was found: 77% in a single location; most of them at a supra-diaphragmatic level. Patients received different first-line treatments, and progression was observed in 3/4 (75%) of the patients who did not receive any type of treatment, 6/23 (26%) who received both chemotherapy (CH) and radiotherapy (RT), 12/43 (27%) who received RT and 7/15 (47%) that received only CH treatment. The mean time to relapse was 3 years and 47% presented relapses beyond 5 years (higher probability in stage IV p < 0.001). This is one of the longest follow-up series of NLPHL published, confirming its excellent prognosis, and that treatments may be adapted to reduce toxicity. Causes of death in these patients are varied, and the minority due to a primary malignancy relapses.
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Affiliation(s)
| | | | - Silvia Sequero
- Department of Medical Oncology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Laura G Carvajal
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Alberto Ruano-Ravina
- Preventive Medicine and Public Health Area, CIBERESP, Santiago de Compostela University, Madrid, Spain
| | - David Aguiar
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - Josep Gumá
- Department of Medical Oncology, Institut d'Oncologia de la Catalunya Sud, Hospital Universitari Sant Joan de Reus, IISPV-URV, Tarragona, Spain
| | - Cristina Q Blanco
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Francisco R García Arroyo
- Department of Medical Oncology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Yago Garitaonaindia
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Spain
| | - Zaida Provencio
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Spain
| | - Virginia Calvo
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Spain
| | | | - Mariano Provencio
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Spain
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8
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Ballas LK, Metzger ML, Milgrom SA, Advani R, Bakst RL, Dabaja BS, Flowers CR, Ha CS, Hoppe BS, Mansur DB, Pinnix CC, Plastaras JP, Roberts KB, Smith SM, Terezakis SA, Constine LS. Nodular lymphocyte predominant Hodgkin lymphoma: executive summary of the American radium society appropriate use criteria. Leuk Lymphoma 2020; 62:1057-1065. [DOI: 10.1080/10428194.2020.1852559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Leslie K. Ballas
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Monika L. Metzger
- St Jude Children’s Research Hospital, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | | | | | | | | | | | - Chul S. Ha
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - David B. Mansur
- University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, OH, USA
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9
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Attarbaschi A, Abla O, Arias Padilla L, Beishuizen A, Burke GAA, Brugières L, Bruneau J, Burkhardt B, d'Amore ESG, Klapper W, Kontny U, Pillon M, Taj M, Turner SD, Uyttebroeck A, Woessmann W, Mellgren K. Rare non-Hodgkin lymphoma of childhood and adolescence: A consensus diagnostic and therapeutic approach to pediatric-type follicular lymphoma, marginal zone lymphoma, and nonanaplastic peripheral T-cell lymphoma. Pediatr Blood Cancer 2020; 67:e28416. [PMID: 32452165 DOI: 10.1002/pbc.28416] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/19/2022]
Abstract
Pediatric-type follicular (PTFL), marginal zone (MZL), and peripheral T-cell lymphoma (PTCL) account each for <2% of childhood non-Hodgkin lymphoma. We present clinical and histopathological features of PTFL, MZL, and few subtypes of PTCL and provide treatment recommendations. For localized PTFL and MZL, watchful waiting after complete resection is the therapy of choice. For PTCL, therapy is subtype-dependent and ranges from a block-like anaplastic large cell lymphoma (ALCL)-derived and, alternatively, leukemia-derived therapy in PTCL not otherwise specified and subcutaneous panniculitis-like T-cell lymphoma to a block-like mature B-NHL-derived or, preferentially, ALCL-derived treatment followed by hematopoietic stem cell transplantation in first remission in hepatosplenic and angioimmunoblastic T-cell lymphoma.
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Affiliation(s)
- Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Oussama Abla
- Division of Hematology and Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Laura Arias Padilla
- Department of Pediatric Hematology and Oncology, University of Münster, Münster, Germany
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - G A Amos Burke
- Department of Pediatric Hematology and Oncology, Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Laurence Brugières
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - Julie Bruneau
- Department of Pathology, Necker Enfants Maladies Hospital, Paris, France
| | - Birgit Burkhardt
- Department of Pediatric Hematology and Oncology, University of Münster, Münster, Germany
| | | | - Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University of Kiel, Kiel, Germany
| | - Udo Kontny
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics and Adolescent Medicine, University Medical Center, Aachen, Germany
| | - Marta Pillon
- Department of Pediatric Hematology and Oncology, University of Padova, Padova, Italy
| | - Mary Taj
- Department of Pediatric Hematology and Oncology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, Addenbrooke's Hospital, Cambridge, United Kingdom.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, University Hospital Hamburg, Eppendorf, Hamburg, Germany
| | - Karin Mellgren
- Department of Pediatric Hematology and Oncology, The Queen Silvia's Hospital for Children and Adolescents, University of Gothenburg, Gothenburg, Sweden
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10
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Bartlett NL. Treatment of Nodular Lymphocyte Hodgkin Lymphoma: The Goldilocks Principle. J Clin Oncol 2020; 38:662-668. [PMID: 31922929 DOI: 10.1200/jco.19.02816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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11
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Marks LJ, Pei Q, Bush R, Buxton A, Appel B, Kelly KM, Schwartz CL, Friedman DL. Outcomes in intermediate-risk pediatric lymphocyte-predominant Hodgkin lymphoma: A report from the Children's Oncology Group. Pediatr Blood Cancer 2018; 65:e27375. [PMID: 30277639 PMCID: PMC6192844 DOI: 10.1002/pbc.27375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/30/2018] [Accepted: 07/05/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE Optimal management of patients with intermediate-risk lymphocyte-predominant Hodgkin lymphoma (LPHL) is unclear due to their small numbers in most clinical trials. Children's Oncology Group AHOD0031, a randomized phase III trial of pediatric patients with intermediate-risk Hodgkin lymphoma (HL), included patients with LPHL. We report the outcomes of these patients and present directions for future therapeutic strategies. PROCEDURE Patients received two cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC) followed by response evaluation. Slow early responders were randomized to two additional ABVE-PC cycles ± two dexamethasone, etoposide, cisplatin, and cytarabine cycles and all received involved field radiotherapy (IFRT). Rapid early responders (RERs) received two additional ABVE-PC cycles. RERs with complete response (CR) were randomized to IFRT or no further therapy. RERs without CR received IFRT. RESULTS Ninety-six (5.6%) of 1711 patients on AHOD0031 had LPHL. Patients with LPHL were more likely to achieve RER (93.6% vs. 81.0%; P = 0.002) and CR (74.2% vs. 49.3%; P = 0.000005) following chemotherapy compared with patients with classical HL. Five-year event-free survival (EFS) was superior in patients with LPHL (92.2%) versus classical HL (83.5%) (P = 0.04), without difference in overall survival (OS). Among RERs with CR following chemotherapy (n = 33), there was no difference in EFS or OS between those randomized to receive or not receive IFRT. CONCLUSION Children and adolescents with intermediate-risk LPHL represent ideal candidates for response-adapted therapy based on their favorable outcomes. The majority of patients treated with the ABVE-PC backbone achieve RER with CR status and can be treated successfully without IFRT.
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Affiliation(s)
- Lianna J. Marks
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Qinglin Pei
- Children’s Oncology Group Statistics & Data Center, University of Florida, Gainesville, FL
| | - Rizvan Bush
- Children’s Oncology Group Statistics & Data Center, Monrovia, CA
| | - Allen Buxton
- Children’s Oncology Group Statistics & Data Center, Monrovia, CA
| | - Burton Appel
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ
| | - Kara M. Kelly
- Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, NY
| | - Cindy L. Schwartz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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12
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Spinner MA, Varma G, Advani RH. Modern principles in the management of nodular lymphocyte-predominant Hodgkin lymphoma. Br J Haematol 2018; 184:17-29. [DOI: 10.1111/bjh.15616] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Michael A. Spinner
- Division of Oncology; Department of Medicine; Stanford University; Stanford CA USA
| | - Gaurav Varma
- Department of Medicine; New York-Presbyterian Hospital/Weill Cornell Medicine; New York NY USA
| | - Ranjana H. Advani
- Division of Oncology; Department of Medicine; Stanford University; Stanford CA USA
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13
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Prasad M, Narula G, Chinnaswamy G, Arora B, Shet T, Panjwani P, Sengar M, Laskar S, Khanna N, Banavali S. Unfavorable presentation but comparable outcome: Presentation and outcome of children with nodular lymphocyte predominant Hodgkin lymphoma from India. Pediatr Blood Cancer 2018; 65:e27288. [PMID: 29893471 DOI: 10.1002/pbc.27288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is an uncommon subtype of Hodgkin lymphoma (HL) with few published studies in children, entirely from North America and Europe. We analyzed clinical features and treatment outcome of pediatric NLPHL. PROCEDURE Children less than 18 years of age diagnosed after histopathology review to have NLPHL between June 1998 and August 2016 were retrospectively analyzed. Descriptive details of clinical presentation and treatment were collected, and outcomes analyzed using Kaplan-Meier survival analysis. RESULTS Of the 42 patients with a confirmed diagnosis of NLPHL during this period, there was complete information on 35. Median age was 11 years (range 6-16 years), male:female ratio was 4.8:1, there were 15, 11, 6, and 3 patients with Stage I, Stage II, Stage III, and Stage IV disease, respectively. Six patients had B symptoms, 10 had bulky disease, and 3 had bone marrow as well as extranodal involvement. Histology was typical NLPHL in 23 and variant in 12. Twenty-nine received chemotherapy, 10 with additional radiation, 3 patients with early stage disease received only radiotherapy and three others underwent complete node resection alone. Median follow-up was 55 months (range 7-165 months), 5 year event-free survival (EFS) was 83.3%, and overall survival 97.1%. Variant NLPHL histology was associated with higher incidence of unfavorable presentation and lower EFS. CONCLUSIONS NLPHL in India has an excellent outcome, despite a higher incidence of unfavorable presentations such as advanced stage disease, B symptoms, and bulky disease. Variant histology is an adverse prognostic factor.
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Affiliation(s)
- Maya Prasad
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Brijesh Arora
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Tanuja Shet
- Homi Bhabha National Institute, Mumbai, India.,Pathology, Tata Memorial Hospital, Mumbai, India
| | | | - Manju Sengar
- Homi Bhabha National Institute, Mumbai, India.,Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Siddharth Laskar
- Homi Bhabha National Institute, Mumbai, India.,Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Nehal Khanna
- Homi Bhabha National Institute, Mumbai, India.,Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shripad Banavali
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
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14
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Ronceray L, Abla O, Barzilai-Birenboim S, Bomken S, Chiang AK, Jazbec J, Kabickova E, Lazic J, Beishuizen A, Mellgren K, Tanaka F, Pillon M, Devalck C, Gouttenoire M, Makarova O, Burkhardt B, Attarbaschi A. Children and adolescents with marginal zone lymphoma have an excellent prognosis with limited chemotherapy or a watch-and-wait strategy after complete resection. Pediatr Blood Cancer 2018; 65. [PMID: 29286565 DOI: 10.1002/pbc.26932] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/15/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
Data on management of pediatric marginal zone lymphoma (MZL) are scarce. This retrospective study assessed characteristics and outcome in 66 patients who were <18 years old. Forty-four (67%) had an extranodal MZL (EMZL), 21 (32%) a nodal MZL (NMZL), and one patient a splenic MZL. Thirty-three patients (50%) received a variable combination of adjuvant chemotherapy/immunotherapy/radiotherapy, while the remainder, including 20 of 21 with NMZL, entered an active observation period. Overall survival was excellent (98 ± 2%), although 11 patients relapsed (17%; NMZL, n = 1; EMZL, n = 10), seven after any therapy and four after complete resection only. In conclusion, outcome of NZML, in particular, seems to be excellent after (in)complete resection and observation only.
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Affiliation(s)
- Leila Ronceray
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Oussama Abla
- Division of Hematology and Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Shlomit Barzilai-Birenboim
- Pediatric Hematology and Oncology, Schneider Children's Medical Center of Israel, Petah-Tivka, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simon Bomken
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Alan Ks Chiang
- Department of Pediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Janez Jazbec
- Division of Pediatrics, Hematology and Oncology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Edita Kabickova
- Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jelena Lazic
- Pediatric Hematology and Oncology, University Children's Hospital, School of Medicine University of Belgrade, Belgrade, Serbia
| | - Auke Beishuizen
- Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Karin Mellgren
- Pediatric Hematology and Oncology, The Queen Silvia's Hospital for Children and Adolescents, University of Göteborg, Göteborg, Sweden
| | - Fumiko Tanaka
- Department of Pediatrics, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Marta Pillon
- Pediatric Hematology and Oncology, University of Padova, Padova, Italy
| | - Christine Devalck
- Pediatric Hematology and Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Marina Gouttenoire
- Pediatric Hematology and Oncology, University Hospital, Saint Etienne, France
| | - Olga Makarova
- Pediatric Hematology and Oncology, University of Münster, Münster, Germany
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology, University of Münster, Münster, Germany
| | - Andishe Attarbaschi
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | -
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
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15
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Eichenauer DA, Engert A. Nodular lymphocyte-predominant Hodgkin lymphoma: a unique disease deserving unique management. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:324-328. [PMID: 29222274 PMCID: PMC6142570 DOI: 10.1182/asheducation-2017.1.324] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma entity with an incidence of 0.1 to 0.2/100 000/y. Compared with the more common subtypes of classical Hodgkin lymphoma, NLPHL is characterized by distinct pathological and clinical features. Histologically, the disease-defining lymphocyte predominant cells consistently express CD20 but lack CD30. Clinically, NLPHL mostly has a rather indolent course, and patients usually are diagnosed in early stages. The prognosis of early-stage NLPHL is excellent, with progression-free survival and overall survival rates exceeding 90% after involved-field radiotherapy (IF-RT) alone (stage IA) or combined modality treatment consisting of a brief chemotherapy with 2 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy followed by IF-RT (early stages other than stage IA). In contrast, patients with advanced disease at diagnosis tend to relapse either with NLPHL histology or with histological transformation into aggressive B-cell non-Hodgkin lymphoma despite more aggressive first-line treatment with 6 to 8 cycles of multiagent chemotherapy. However, even NLPHL patients with multiple relapses successfully respond to salvage therapy in many cases. Salvage therapies range from single-agent anti-CD20 antibody treatment to high-dose chemotherapy followed by autologous stem cell transplantation. Treatment at disease recurrence should be chosen on the basis of various factors, including histology at relapse, time to relapse, extent of disease at relapse, and prior treatment. Because death among NLPHL patients is more often caused by therapy-related late effects than lymphoma-related complications, optimizing the risk-benefit ratio of treatment by decreasing toxicity whenever possible is the major goal of clinical research in this disease.
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Affiliation(s)
- Dennis A. Eichenauer
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany; and
- German Hodgkin Study Group, Cologne, Germany
| | - Andreas Engert
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany; and
- German Hodgkin Study Group, Cologne, Germany
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16
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Encouraging activity for R-CHOP in advanced stage nodular lymphocyte-predominant Hodgkin lymphoma. Blood 2017; 130:472-477. [PMID: 28522441 DOI: 10.1182/blood-2017-02-766121] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/30/2017] [Indexed: 12/16/2022] Open
Abstract
Nodular lymphocyte Hodgkin lymphoma (NLPHL) is a rare disease for which the optimal therapy is unknown. We hypothesized that rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) could decrease rates of relapse and transformation. We retrospectively reviewed patients with NLPHL diagnosed between 1995 and 2015 confirmed by central pathologic review. Fifty-nine had sufficient treatment and follow-up data for analysis. We described progression-free survival (PFS), overall survival (OS), and histologic transformation according to treatment strategy and explored prognostic factors for PFS and OS. The median age at diagnosis was 41 years; 75% were male, and 61% had a typical growth pattern. Twenty-seven patients were treated with R-CHOP with an overall response rate of 100% (complete responses 89%). The median follow-up was 6.7 years, and the estimated 5- and 10-year PFS rates for patients treated with R-CHOP were 88.5% (95% confidence interval [CI], 68.4% to 96.1%) and 59.3 (95% CI, 25.3% to 89.1%), respectively. Excluding patients with histologic transformation at diagnosis, the 5-year cumulative incidence of histologic transformation was 2% (95% CI, 87% to 100%). No patient treated with R-CHOP experienced transformation. A high-risk score from the German Hodgkin Study Group was adversely prognostic for OS (P = .036), whereas male sex and splenic involvement were adversely prognostic for PFS (P = .006 and .002, respectively) but not OS. Our data support a potential role for R-CHOP in patients with NLPHL. Larger prospective trials are needed to define the optimal chemotherapy regimen.
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17
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Radhakrishnan V, Kapoor G, Arora B, Bansal D, Vora T, Prasad M, Chinnaswamy G, Laskar S, Agarwala S, Kaur T, Rath GK, Bakhshi S. Management of Hodgkins Lymphoma: ICMR Consensus Document. Indian J Pediatr 2017; 84:371-381. [PMID: 28357582 DOI: 10.1007/s12098-017-2304-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/30/2017] [Indexed: 11/28/2022]
Abstract
Pediatric Hodgkins lymphoma is a highly curable disease even in the developing world. Current treatment paradigms follow a risk and response based approach. The goal is to minimise treatment related short and long-term toxicity while maintaining excellent survival. A confirmed histopathological diagnosis and full staging work-up are essential prior to embarking on treatment and guidelines for these are provided in the text. All patients require combination chemotherapy while radiotherapy is usually reserved for a select subgroup depending on the protocol used. It is important to follow these patients for relapse in the first five years and life-long for late effects as most of them will be cured.
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Affiliation(s)
- Venkatraman Radhakrishnan
- Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India
| | - Gauri Kapoor
- Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute & Research Center, Rohini, Sector 5, Delhi, 110085, India.
| | - Brijesh Arora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Deepak Bansal
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tanvir Kaur
- NCD Division, Indian Council of Medical Research (ICMR), New Delhi, India
| | - G K Rath
- Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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18
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Shankar AG, Roques G, Kirkwood AA, Lambilliotte A, Freund K, Leblanc T, Hayward J, Abbou S, Ramsay AD, Schmitt C, Gorde-Grosjean S, Pacquement H, Haouy S, Boudjemaa S, Aladjidi N, Hall GW, Landman-Parker J. Advanced stage nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents: clinical characteristics and treatment outcome - a report from the SFCE & CCLG groups. Br J Haematol 2017; 177:106-115. [PMID: 28220934 DOI: 10.1111/bjh.14518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/07/2016] [Indexed: 12/21/2022]
Abstract
Advanced stage nodular lymphocyte predominant Hodgkin lymphoma (nLPHL) is extremely rare in children and as a consequence, optimal treatment for this group of patients has not been established. Here we retrospectively evaluated the treatments and treatment outcomes of 41 of our patients from the UK and France with advanced stage nLPHL. Most patients received chemotherapy, some with the addition of the anti CD20 antibody rituximab or radiotherapy. Chemotherapy regimens were diverse and followed either classical Hodgkin lymphoma or B non-Hodgkin lymphoma protocols. All 41 patients achieved a complete remission with first line treatment and 40 patients are alive and well in remission. Eight patients subsequently relapsed and 1 patient died of secondary cancer (9 progression-free survival events). The median time to progression for those who progressed was 21 months (5·9-73·8). The median time since last diagnosis is 87·3 months (8·44-179·20). Thirty-six (90%), 30 (75%) and 27 (68%) patients have been in remission for more than 12, 24 and 36 months, respectively. Overall, the use of rituximab combined with multi-agent chemotherapy as first line treatment seems to be a reasonable therapeutic option.
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Affiliation(s)
- Ananth G Shankar
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Katja Freund
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Janis Hayward
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | | | - Alan D Ramsay
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Sabah Boudjemaa
- Service d'hématologie et d'oncologie pédiatrique, Hopital A, Trousseau, 75571 APHP/UPMC Univ Paris 06, Paris, France
| | | | - Georgina W Hall
- Paediatric Haematology/Oncology Unit, Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Judith Landman-Parker
- Service d'hématologie et d'oncologie pédiatrique, Hopital A, Trousseau, 75571 APHP/UPMC Univ Paris 06, Paris, France
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19
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Mann G, Holter W. [Treatment of low-risk pediatric lymphocyte-predominant Hodgkin lymphoma]. Strahlenther Onkol 2016; 192:827-829. [PMID: 27596219 DOI: 10.1007/s00066-016-1044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Georg Mann
- St. Anna Kinderkrebsforschung, St. Anna Kinderspital, UKKJ, MUW, Kinderspitalgasse 6, 1090, Wien, Österreich.
| | - Wolfgang Holter
- St. Anna Kinderkrebsforschung, St. Anna Kinderspital, UKKJ, MUW, Kinderspitalgasse 6, 1090, Wien, Österreich
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20
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Körholz D, Mauz-Körholz C, Gattenlöhner S, Klapper W, Burkhardt B, Woessmann W. Lymphome bei Kindern und Jugendlichen. DER ONKOLOGE 2016. [DOI: 10.1007/s00761-016-0111-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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21
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Effect of chemotherapy alone with adult chemotherapy regimens on prognosis of children and adolescents with Hodgkin's disease. Jpn J Clin Oncol 2016; 46:667-73. [DOI: 10.1093/jjco/hyw051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/27/2016] [Indexed: 11/14/2022] Open
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22
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Appel BE, Chen L, Buxton AB, Hutchison RE, Hodgson DC, Ehrlich PF, Constine LS, Schwartz CL. Minimal Treatment of Low-Risk, Pediatric Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the Children's Oncology Group. J Clin Oncol 2016; 34:2372-9. [PMID: 27185849 DOI: 10.1200/jco.2015.65.3469] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Children's Oncology Group study AHOD03P1 was designed to determine whether excellent outcomes can be maintained for patients with low-risk, pediatric lymphocyte-predominant Hodgkin lymphoma (LPHL) with a strategy of resection alone or minimal chemotherapy. PATIENTS AND METHODS Patients with stage IA LPHL in a single node that was completely resected were observed without further therapy; recurrences were treated with three cycles of doxorubicin/vincristine/prednisone/cyclophosphamide (AV-PC). Patients with unresected stage IA or stage IIA LPHL were treated with three cycles of AV-PC. Patients with less than a complete response (CR) to AV-PC received 21-Gy involved-field radiation therapy (IFRT). RESULTS A total of 183 eligible patients were enrolled; 178 were evaluable. Of these, 52 patients underwent complete resection of a single node. There were 13 relapses at a median of 11.5 months; 5-year event-free survival (EFS) was 77% (range, 62% to 87%). A total of 135 patients received AV-PC; 126 were treated at diagnosis and nine at relapse after surgery alone. Eleven patients receiving AV-PC had less than CR and received IFRT. Fourteen first events occurred among 135 patients (12 relapses and two second malignancies). Two relapses occurred in patients who had received IFRT. Five-year EFS was 88.8% (95% CI, 81.8% to 93.2%). Five-year EFS for the entire cohort was 85.5% (95% CI, 79.2% to 90.1%); overall survival was 100%. CONCLUSION Some 75% of highly selected pediatric patients with LPHL may be spared chemotherapy after surgical resection alone. Pediatric LPHL has excellent EFS with chemotherapy that is less intensive than standard regimens; > 90% of patients can avoid radiation therapy. The salvage rate for the few relapses is high, with 100% survival overall.
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Affiliation(s)
- Burton E Appel
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Lu Chen
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Allen B Buxton
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert E Hutchison
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - David C Hodgson
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter F Ehrlich
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louis S Constine
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cindy L Schwartz
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
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23
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Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma with distinct clinicopathologic features. It is typified by the presence of lymphocyte predominant (LP) cells, which are CD20(+) but CD15(-) and CD30(-) and are found scattered amongst small B lymphocytes arranged in a nodular pattern. Despite frequent and often late or multiple relapses, the prognosis of NLPHL is very favorable. There is an inherent risk of secondary aggressive non-Hodgkin lymphoma (NHL) and studies support that risk is highest in those with splenic involvement at presentation. Given disease rarity, the optimal management is unclear and opinions differ as to whether treatment paradigms should be similar to or differ from those for classical Hodgkin lymphoma (CHL). This review provides an overview of the existing literature describing pathological subtypes, outcome and treatment approaches for NLPHL.
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Affiliation(s)
- Kerry J Savage
- Department of Medical Oncology, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.
| | - Anja Mottok
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
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Shankar AG, Kirkwood AA, Depani S, Bianchi E, Hayward J, Ramsay AD, Hall GW. Relapsed or poorly responsive nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents - a report from the United Kingdom's Children's Cancer and Leukaemia Study Group. Br J Haematol 2016; 173:421-31. [PMID: 26996288 DOI: 10.1111/bjh.13979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/21/2015] [Indexed: 01/02/2023]
Abstract
There is a paucity of data on the treatment outcome in children with relapsed or poorly responsive nodular lymphocyte predominant Hodgkin lymphoma (nLPHL). This retrospective report evaluates the treatment outcome in a national cohort of children with relapsed or poorly responsive nLPHL. A total of 37 patients, 22 with relapsed and 15 with poorly responding disease, are the subjects of this report. Of the 22 patients with relapsed nLPHL, 11 had relapsed after primary excision biopsy, 10 after chemotherapy and 1 after chemotherapy and involved field radiotherapy. The majority had localized disease at relapse. The median time to relapse was 8 months after chemotherapy and 11 months after excision biopsy. Seven of the 15 patients with poorly responding nLPHL had variant histology. Three patients with initial poor response did not receive any further treatment and have had no disease progression. Transformation to diffuse large B cell lymphoma, in addition to evolution from typical to variant nLPHL occurred in one patient each. Thirty-four patients have been successfully re-treated with second chemotherapy or radiotherapy. Multiple relapses were uncommon but treatable. Relapse or poorly responsive nLPHL is fully salvageable with either additional chemotherapy and or radiotherapy.
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Affiliation(s)
- Ananth G Shankar
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Sarita Depani
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eleonora Bianchi
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Janis Hayward
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Alan D Ramsay
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgina W Hall
- Department of Paediatric Oncology and Haematology, Children's Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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25
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McKay P, Fielding P, Gallop-Evans E, Hall GW, Lambert J, Leach M, Marafioti T, McNamara C. Guidelines for the investigation and management of nodular lymphocyte predominant Hodgkin lymphoma. Br J Haematol 2015; 172:32-43. [PMID: 26538004 DOI: 10.1111/bjh.13842] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Pamela McKay
- Department of Haematology; Beatson West of Scotland Cancer Centre; Gartnavel Hospital; Glasgow UK
| | - Patrick Fielding
- PETIC; Department of Radiology; University Hospital of Wales; Cardiff UK
| | - Eve Gallop-Evans
- Department of Clinical Oncology; Velindre Cancer Centre; Cardiff UK
| | - Georgina W. Hall
- Paediatric Haematology/Oncology Unit; Children's Hospital; John Radcliffe Hospital; Headington Oxford
| | - Jonathan Lambert
- Department of Haematology; University College London Hospitals; London UK
| | - Mike Leach
- Department of Haematology; Beatson West of Scotland Cancer Centre; Gartnavel Hospital; Glasgow UK
| | - Teresa Marafioti
- Department of Pathology; University College London Hospitals; London UK
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26
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Mauz-Körholz C, Metzger ML, Kelly KM, Schwartz CL, Castellanos ME, Dieckmann K, Kluge R, Körholz D. Pediatric Hodgkin Lymphoma. J Clin Oncol 2015; 33:2975-85. [PMID: 26304892 DOI: 10.1200/jco.2014.59.4853] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Hodgkin lymphoma (HL) is one of the most curable pediatric and adult cancers, with long-term survival rates now exceeding 90% after treatment with chemotherapy alone or combined with radiotherapy (RT). Of note, global collaboration in clinical trials within cooperative pediatric HL study groups has resulted in continued progress; however, survivors of pediatric HL are at high risk of potentially life-limiting second cancers and treatment-associated cardiovascular disease. Over the last three decades, all major pediatric and several adult HL study groups have followed the paradigm of response-based treatment adaptation and toxicity sparing through the reduction or elimination of RT and tailoring of chemotherapy. High treatment efficacy is achieved using dose-dense chemotherapy. Refinement and reduction of RT have been implemented on the basis of results from collaborative group studies, such that radiation has been completely eliminated for certain subgroups of patients. Because pediatric staging and response criteria are not uniform, comparing the results of trial series among different pediatric and adult study groups remains difficult; thus, initiatives to harmonize criteria are desperately needed. A dynamic harmonization process is of utmost importance to standardize therapeutic risk stratification and response definitions as well as improve the care of children with HL in resource-restricted environments.
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Affiliation(s)
- Christine Mauz-Körholz
- Christine Mauz-Körholz and Dieter Körholz, Martin-Luther-University Medical Center, Halle, Germany; Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Kara M. Kelly, Columbia University Medical Center, New York, NY; Cindy L. Schwartz, MD Anderson Cancer Center, Houston, TX; Mauricio E. Castellanos, Unidad Nacional Oncologia Pediatrica, Guatemala City, Guatemala; Karin Dieckmann, Medical University of Vienna, Vienna, Austria; and Regine Kluge, University of Leipzig, Leipzig, Germany.
| | - Monika L Metzger
- Christine Mauz-Körholz and Dieter Körholz, Martin-Luther-University Medical Center, Halle, Germany; Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Kara M. Kelly, Columbia University Medical Center, New York, NY; Cindy L. Schwartz, MD Anderson Cancer Center, Houston, TX; Mauricio E. Castellanos, Unidad Nacional Oncologia Pediatrica, Guatemala City, Guatemala; Karin Dieckmann, Medical University of Vienna, Vienna, Austria; and Regine Kluge, University of Leipzig, Leipzig, Germany
| | - Kara M Kelly
- Christine Mauz-Körholz and Dieter Körholz, Martin-Luther-University Medical Center, Halle, Germany; Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Kara M. Kelly, Columbia University Medical Center, New York, NY; Cindy L. Schwartz, MD Anderson Cancer Center, Houston, TX; Mauricio E. Castellanos, Unidad Nacional Oncologia Pediatrica, Guatemala City, Guatemala; Karin Dieckmann, Medical University of Vienna, Vienna, Austria; and Regine Kluge, University of Leipzig, Leipzig, Germany
| | - Cindy L Schwartz
- Christine Mauz-Körholz and Dieter Körholz, Martin-Luther-University Medical Center, Halle, Germany; Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Kara M. Kelly, Columbia University Medical Center, New York, NY; Cindy L. Schwartz, MD Anderson Cancer Center, Houston, TX; Mauricio E. Castellanos, Unidad Nacional Oncologia Pediatrica, Guatemala City, Guatemala; Karin Dieckmann, Medical University of Vienna, Vienna, Austria; and Regine Kluge, University of Leipzig, Leipzig, Germany
| | - Mauricio E Castellanos
- Christine Mauz-Körholz and Dieter Körholz, Martin-Luther-University Medical Center, Halle, Germany; Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Kara M. Kelly, Columbia University Medical Center, New York, NY; Cindy L. Schwartz, MD Anderson Cancer Center, Houston, TX; Mauricio E. Castellanos, Unidad Nacional Oncologia Pediatrica, Guatemala City, Guatemala; Karin Dieckmann, Medical University of Vienna, Vienna, Austria; and Regine Kluge, University of Leipzig, Leipzig, Germany
| | - Karin Dieckmann
- Christine Mauz-Körholz and Dieter Körholz, Martin-Luther-University Medical Center, Halle, Germany; Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Kara M. Kelly, Columbia University Medical Center, New York, NY; Cindy L. Schwartz, MD Anderson Cancer Center, Houston, TX; Mauricio E. Castellanos, Unidad Nacional Oncologia Pediatrica, Guatemala City, Guatemala; Karin Dieckmann, Medical University of Vienna, Vienna, Austria; and Regine Kluge, University of Leipzig, Leipzig, Germany
| | - Regine Kluge
- Christine Mauz-Körholz and Dieter Körholz, Martin-Luther-University Medical Center, Halle, Germany; Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Kara M. Kelly, Columbia University Medical Center, New York, NY; Cindy L. Schwartz, MD Anderson Cancer Center, Houston, TX; Mauricio E. Castellanos, Unidad Nacional Oncologia Pediatrica, Guatemala City, Guatemala; Karin Dieckmann, Medical University of Vienna, Vienna, Austria; and Regine Kluge, University of Leipzig, Leipzig, Germany
| | - Dieter Körholz
- Christine Mauz-Körholz and Dieter Körholz, Martin-Luther-University Medical Center, Halle, Germany; Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Kara M. Kelly, Columbia University Medical Center, New York, NY; Cindy L. Schwartz, MD Anderson Cancer Center, Houston, TX; Mauricio E. Castellanos, Unidad Nacional Oncologia Pediatrica, Guatemala City, Guatemala; Karin Dieckmann, Medical University of Vienna, Vienna, Austria; and Regine Kluge, University of Leipzig, Leipzig, Germany
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Shankar AG, Kirkwood AA, Hall GW, Hayward J, O'Hare P, Ramsay AD. Childhood and Adolescent nodular lymphocyte predominant Hodgkin lymphoma - A review of clinical outcome based on the histological variants. Br J Haematol 2015; 171:254-262. [PMID: 26115355 DOI: 10.1111/bjh.13540] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/12/2015] [Indexed: 01/08/2023]
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (nLPHL) comprises approximately 10-12% of all childhood Hodgkin lymphoma. As the majority have low stage disease recent years have seen a de-escalation of treatment intensity to avoid treatment-related morbidity. This report evaluates treatment outcome in children with histopathological variants of nLPHL after therapy de-escalation. Biopsies from 60 patients were reviewed and histology categorized as typical (n = 47; 78%) or variant nLPHL (n = 13; 22%). Furthermore, presence of immunoglobulin D (IgD) expression by the lymphocyte predominant (LP) cells was assessed in 41 patients. Treatment outcomes were compared according to treatment received and histopathology of nLPHL. Compared to typical nLPHL, children with variant nLPHL had higher stage disease at diagnosis (stage III: 3/13; 23% vs. 3/47; 6%, P = 0·11), lower complete response rates (6/13; 46% vs. 38/47; 81%, P = 0·029) and higher relapse rates (2/13; 15% vs. 2/47; 4%, P = 0·20). Additionally, IgD expression by LP cells was associated with poorer treatment response and was more commonly seen in patients with variant nLPHL. (11/13; 85% vs. 15/28; 54%, P = 0·08). Variant histology appears to be indicative of a poorer prognosis in patients with early stage disease, and may be an important factor to take into account when moving towards reduced intensity treatment for nLPHL.
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Affiliation(s)
- Ananth G Shankar
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Georgina W Hall
- Department of Paediatric and Adolescent Oncology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, London, UK
| | - Janis Hayward
- School of Cancer Sciences, Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Patricia O'Hare
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alan D Ramsay
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
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28
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Eyre TA, Gatter K, Collins GP, Hall GW, Watson C, Hatton CS. Incidence, management, and outcome of high-grade transformation of nodular lymphocyte predominant Hodgkin lymphoma: long-term outcomes from a 30-year experience. Am J Hematol 2015; 90:E103-10. [PMID: 25715900 DOI: 10.1002/ajh.23989] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 12/19/2022]
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare form of Hodgkin lymphoma that typically presents as early stage, indolent disease in young adult males. The relationship between NLPHL and DLBCL is incompletely understood, and there remains a paucity of data with regard the incidence and management of high-grade transformation. We report the largest study to date describing the incidence, management and long-term outcome of 26 cases of high-grade transformation of NLPHL over a 30-year period. We report a transformation incidence of 17.0%. Bone marrow, splenic, and liver infiltration with DLBCL was frequent. Patients with an aa-IPI 2-3 have poorer OS and PFS (P = 0.034 and P = 0.009, respectively). Although the approach to treatment was somewhat variable, typically young, otherwise fit patients received anthracycline-based induction, platinum-based consolidation with stem cell harvesting, followed by autologous SCT with BEAM conditioning. Long-term (5 year) PFS was over 60% with this approach, and comparable to our de novo DLBCL historical age and time period-matched cohort largely treated with CHOP-like chemotherapy alone. The transformation rate of 17.0% highlights the importance of accurate initial diagnosis, long-term follow-up, and re-biopsy at relapse.
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Affiliation(s)
- Toby A. Eyre
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Kevin Gatter
- Nuffield Division of Clinical Laboratory Sciences; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Graham P. Collins
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Georgina W. Hall
- Paediatric Haematology & Oncology Unit; Children's Hospital; John Radcliffe Hospital, Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Caroline Watson
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Chris S.R. Hatton
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
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29
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Lymphocyte-Predominant Hodgkin's Disease in Children: A Case Study and Review of the Literature. Case Rep Oncol Med 2015; 2015:351431. [PMID: 25878913 PMCID: PMC4388010 DOI: 10.1155/2015/351431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/26/2015] [Accepted: 03/10/2015] [Indexed: 11/18/2022] Open
Abstract
A three-year-old boy presented with an enlarging neck mass. Biopsy demonstrated IgD-positive nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), which was staged as IIa. The patient received cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with rituximab and had excellent results. NLPHL is a relatively rare disease that is biologically distinct from classic Hodgkin lymphoma (cHL). NLPHL is a B-cell malignancy likely of germinal center origin that has an overall good prognosis and favorable response to treatment. Unlike cHL, NLPHL is ubiquitously CD20-positive. Recent evidence supports the efficacy of targeted anti-CD20 therapy in NLPHL, though prospective data is limited. This case demonstrates several unique features of NLPHL and further supports the use of rituximab in front-line therapy. The clinical characteristics among patients at various ages are discussed with a special focus on the IgD-positive subtype. A thorough literature search demonstrates this to be the youngest patient with NLPHL yet described.
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30
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Giulino-Roth L, Keller FG, Hodgson DC, Kelly KM. Current approaches in the management of low risk Hodgkin lymphoma in children and adolescents. Br J Haematol 2015; 169:647-60. [PMID: 25824371 DOI: 10.1111/bjh.13372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The outcome for children and adolescents with low risk Hodgkin lymphoma (HL) is excellent, with event-free survival >85% and overall survival >95%. Historically, however, treatment has come at the cost of significant long-term toxicity from chemotherapy, radiation or a combination of these. Recent treatment strategies have focused on maintaining high event-free and overall survival while minimizing the use of therapy associated with late effects. The strategies used to achieve this vary greatly among paediatric cooperative groups and there is no one standard treatment for children with low risk HL. This review summaries recent clinical trials in paediatric low risk HL and addresses some of the important considerations when comparing trials, including differences in the definition of low risk HL, differences in outcome among histological subtypes and varying approaches to reduce or eliminate radiation therapy. Recommendations are provided for the treatment of children with low risk HL outside the setting of a clinical trial.
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Affiliation(s)
- Lisa Giulino-Roth
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.,Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank G Keller
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, USA
| | - Kara M Kelly
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
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31
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Lymphome de Hodgkin nodulaire à prédominance lymphocytaire chez l’enfant: présentation clinique, biologique et prise en charge actuelle. Bull Cancer 2014; 101:881-90. [DOI: 10.1684/bdc.2014.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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32
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Grellier JF, Vercellino L, Leblanc T, Merlet P, Thieblemont C, Weinmann P, Toubert ME, Berenger N, Brière J, Brice P. Performance of FDG PET/CT at initial diagnosis in a rare lymphoma: nodular lymphocyte-predominant Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2014; 41:2023-30. [PMID: 24965842 DOI: 10.1007/s00259-014-2825-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/26/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare Hodgkin lymphoma distinguished from classical Hodgkin lymphoma (cHL) by the nature of the neoplastic cells which express B-cell markers. We wanted to determine the diagnostic performance of FDG PET/CT in initial assessment and its therapeutic impact on staging. METHODS We retrospectively studied a population of 35 patients with NLPHL (8 previously treated for NLHPL, 27 untreated). All patients underwent an initial staging by pretherapeutic FDG PET/CT. The impact on initial stage or relapse stage was assessed by an independent physician. RESULTS In a per-patient analysis, the sensitivity of the pretherapeutic FDG PET/CT was 100%. In a per-site analysis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of pretherapeutic FDG PET/CT were 100%, 99%, 97%, 100% and 99%, respectively. Pretherapeutic FDG PET/CT led to a change in the initial stage/relapse stage in 12 of the 35 patients (34%). In contrast to previous results established without FDG PET/CT, 20% of patient had osteomedullary lesions. CONCLUSION Pretherapeutic FDG PET/CT has excellent performance for initial staging or relapse staging of NLPHL.
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Affiliation(s)
- Jean François Grellier
- AP-HP- Hôpital Européen Georges Pompidou, Service de médecine nucléaire, Paris, 75015, France,
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33
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Belgaumi AF, Al-Kofide AA. Pediatric Hodgkin Lymphoma: Making Progress. CURRENT PEDIATRICS REPORTS 2014. [DOI: 10.1007/s40124-013-0034-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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34
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Goel A, Fan W, Patel AA, Devabhaktuni M, Grossbard ML. Nodular lymphocyte predominant hodgkin lymphoma: biology, diagnosis and treatment. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:261-70. [PMID: 24650975 DOI: 10.1016/j.clml.2014.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 11/26/2022]
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is an uncommon variant of classical Hodgkin lymphoma. It is characterized histologically by presence of lymphohistiocytic cells which have B-cell phenotype, are positive for CD19, CD20, CD45, CD79a, BOB.1, Oct.2, and negative for CD15 and CD30. Patients often present with early stage of disease and do not have classical B symptoms. The clinical behavior appears to mimic that of an indolent non-Hodgkin lymphoma more than that of classical Hodgkin disease. The purpose of the present report is to define the biology of NLPHL, review its clinical presentation, and summarize the available clinical data regarding treatment.
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Affiliation(s)
- Anupama Goel
- Department of Hematology and Oncology, St Luke's Roosevelt Hospital Center, New York, NY; Mt Sinai Health System.
| | - Wen Fan
- Department of Hematology and Oncology, St Luke's Roosevelt Hospital Center, New York, NY; Mt Sinai Health System
| | - Amit A Patel
- Department of Hematology and Oncology, St Luke's Roosevelt Hospital Center, New York, NY
| | - Madhuri Devabhaktuni
- Department of Hematology and Oncology, St Luke's Roosevelt Hospital Center, New York, NY
| | - Michael L Grossbard
- Department of Hematology and Oncology, St Luke's Roosevelt Hospital Center, New York, NY; Mt Sinai Health System
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35
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Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is an uncommon entity that, in contrast to classical Hodgkin lymphoma (cHL), universally expresses CD20, a hallmark of the disease. The majority of the patients present with early-stage disease, and treatment with local radiation provides excellent disease control and overall survival (OS). For locally extensive or advanced stages, paradigms used for cHL have been employed, with similar outcomes. Unlike cHL, late relapses may occur, as well as a propensity to transform to an aggressive B-cell non-Hodgkin lymphoma that underscores the importance of long-term follow-up and rebiopsy at the time of relapse. Deaths caused by NLPHL are uncommon, and in older series, secondary malignancies and other treatment-related toxicities contributed appreciably to overall mortality. Expression of CD20 in NLPHL has led to the evaluation of rituximab as a therapeutic option. Although results with single-agent rituximab in the front-line setting are inferior to conventional therapy, rituximab is a reasonable choice for relapsed disease because of the high overall response rate and excellent tolerability. Most patients have a long OS; therefore, overall goals of therapy should be to minimize the risk for relapse and long-term toxicity.
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36
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Children and adolescents with follicular lymphoma have an excellent prognosis with either limited chemotherapy or with a “watch and wait” strategy after complete resection. Ann Hematol 2013; 92:1537-41. [DOI: 10.1007/s00277-013-1785-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/02/2013] [Indexed: 12/12/2022]
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37
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Xing KH, Savage KJ. Modern management of lymphocyte predominant Hodgkin lymphoma. Br J Haematol 2013; 161:316-29. [DOI: 10.1111/bjh.12244] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Katharine H. Xing
- Department of Medical Oncology; British Columbia Cancer Agency; Vancouver; BC; Canada
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38
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Appel BE, Chen L, Buxton A, Wolden SL, Hodgson DC, Nachman JB. Impact of low-dose involved-field radiation therapy on pediatric patients with lymphocyte-predominant Hodgkin lymphoma treated with chemotherapy: a report from the Children's Oncology Group. Pediatr Blood Cancer 2012; 59:1284-9. [PMID: 22847767 PMCID: PMC3468707 DOI: 10.1002/pbc.24258] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 06/14/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Treatment of pediatric lymphocyte-predominant Hodgkin lymphoma (LPHL) is controversial but has typically consisted of both chemotherapy and radiation. Radiation therapy is associated with potential late effects in children and adolescents. We examined the impact of radiation therapy on long-term outcome of patients with LPHL treated on CCG-5942, a large pediatric cooperative group study of Hodgkin lymphoma (HL). PROCEDURE Eighty-two patients with LPHL were registered on CCG-5942. Fifty-two patients (63%) received chemotherapy alone; 29 patients (35%) received chemotherapy followed by involved-field radiation therapy (IFRT). RESULTS The median follow-up of the LPHL patients is 7.7 years; 63 patients (77%) have >5 years of follow-up. The 5-year event-free survival (EFS) and overall survival (OS) were 97% and 100%. Two relapses occurred, both in patients who did not receive IFRT. There were no significant differences in EFS or OS between patients who received or did not receive IFRT. CONCLUSIONS This subset analysis demonstrates the chemosensitivity of pediatric LPHL. Patients who had a complete response to chemotherapy had an excellent EFS and OS without the addition of radiotherapy.
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Affiliation(s)
- Burton E. Appel
- Tomorrows Children’s Institute, Hackensack University Medical Center, Hackensack, NJ
| | - Lu Chen
- Children’s Oncology Group Operations Center, Arcadia, CA
| | - Allen Buxton
- Children’s Oncology Group Operations Center, Arcadia, CA
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39
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Shankar A, Daw S. Nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents--a comprehensive review of biology, clinical course and treatment options. Br J Haematol 2012; 159:288-98. [PMID: 22994199 DOI: 10.1111/bjh.12055] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/16/2012] [Indexed: 12/19/2022]
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (nLPHL) is a unique variant of Hodgkin lymphoma with an overall good prognosis. It is conspicuously different from classical Hodgkin lymphoma (cHL) and is now recognized as distinctive form of B cell lymphoma. Although it has an indolent clinical course, it has a propensity for multiple and often late relapses. Although the majority of children present with early stage disease and without B symptoms, treatment strategy has, until recently, been identical to that used for cHL. This approach is excessively toxic as it predisposes these children and adolescents to serious late effects including end organ damage to heart, gonads, lungs, thyroid and second malignant neoplasms. The aim of this article is to review the published literature on the treatment outcomes of nLPHL in affected children and adolescents, and discuss the options for treatment including surgery, chemotherapy, radiotherapy and targeted anti-CD 20 antibody therapy.
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Affiliation(s)
- Ananth Shankar
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
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