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. 2019 May 16;133(20):2121-2129.
doi: 10.1182/blood-2018-10-877761. Epub 2019 Feb 15.

Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma

Sven Borchmann  1   2 , Erel Joffe  1   3 , Craig H Moskowitz  1 , Andrew D Zelenetz  1 , Ariela Noy  1 , Carol S Portlock  1 , John F Gerecitano  1 , Connie L Batlevi  1 , Philip C Caron  1 , Pamela Drullinsky  1   4 , Audrey Hamilton  1 , Paul A Hamlin Jr  1 , Steven M Horwitz  1 , Anita Kumar  1 , Matthew J Matasar  1 , Alison J Moskowitz  1 , Colette N Owens  1   5 , M Lia Palomba  1 , Anas Younes  1 , David J Straus  1
Affiliations

Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma

Sven Borchmann et al. Blood. .

Abstract

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of lymphoma that, like other Hodgkin lymphomas, has historically been treated aggressively. However, in most cases, NLPHL has an indolent course, which raises the question of to what extent these patients require aggressive upfront treatment. We describe the management and outcomes of consecutive NLPHL patients diagnosed at Memorial Sloan Kettering Cancer Center (MSK), with a focus on evaluating active surveillance. All patients aged 16 years or older diagnosed and followed at MSK between 1974 and 2016 were included. Treatment outcomes were compared between management with active surveillance and other strategies. We identified 163 consecutive patients who were treated with radiotherapy alone (46%), active surveillance (23%), chemotherapy (16%), combined modality (12%), or rituximab monotherapy (4%). Median follow-up was 69 months. Five-year progression-free survival (PFS), second PFS (PFS2), and overall survival (OS) estimates were 85% (95% confidence interval [CI], 78-90), 97% (95% CI, 92-99), and 99% (95% CI, 95-100), respectively. Only 1 of 7 deaths was lymphoma related. Patients managed with active surveillance had slightly shorter PFS than those receiving any active treatment, with 5-year PFS of 77% (95% CI, 56-89) vs 87% (95% CI, 79-92; P = .017). This difference did not translate into better PFS2 or OS. Only 10 patients managed with active surveillance (27%) eventually required treatment, after a median of 61 months, and none died. NLPHL has an excellent prognosis. Within the limitations of a retrospective analysis, active surveillance is a viable initial management strategy for selected NLPHL patients.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
PFS and PFS2 for treatment and active surveillance groups. PFS (A) and PFS2 (B) curves by any other treatment (n = 126) vs active surveillance (n = 37).
Figure 2.
Figure 2.
OS for treatment and active surveillance groups. OS curves by any other treatment (n = 126) vs active surveillance (n = 37).
See this image and copyright information in PMC

Comment in

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