Long-term follow-up of nodular lymphocyte-predominant Hodgkin lymphoma treated in the GHSG HD7 to HD15 trials
The largest long-term series of nodular lymphocyte-predominant Hodgkin lymphoma found that three-quarters of patients were still free of the disease ten years after standard Hodgkin lymphoma treatment and more than nine in ten were alive, but most of the deaths came from second cancers and treatment effects rather than from the lymphoma itself.
Overview
Retrospective analysis of 471 patients with nodular lymphocyte-predominant Hodgkin lymphoma (251 early, 76 intermediate and 144 advanced stage) who received stage-adapted first-line treatment (radiotherapy alone, chemotherapy alone or combined modality) within the randomised German Hodgkin Study Group trials HD7 to HD15. Median age was 39 and three-quarters were men; median observation time was 9.2 years.
At ten years progression-free survival was 75.5 percent and overall survival 92.1 percent (early stages 79.7 and 93.3 percent; intermediate 72.1 and 96.2 percent; advanced 69.8 and 87.4 percent). Forty-eight patients (10.2 percent) developed a second malignancy and 43 (9.1 percent) died, but only 10 deaths were from the lymphoma; 20 were from second malignancies and 13 from non-malignant conditions possibly related to treatment. The authors concluded that outcomes with Hodgkin-directed therapy are good but that toxicity must be reduced in standard-risk patients and results improved in high-risk ones.
- Ten-year progression-free survival 75.5 percent and overall survival 92.1 percent across 471 patients.
- Outcomes by stage: early 79.7 and 93.3 percent, intermediate 72.1 and 96.2 percent, advanced 69.8 and 87.4 percent (progression-free and overall survival at ten years).
- Second malignancies in 10.2 percent of patients; of 43 deaths only 10 were from the lymphoma, against 20 from second malignancies and 13 from possibly treatment-related conditions.
Nodular lymphocyte-predominant Hodgkin lymphoma is rarely fatal when treated with standard Hodgkin lymphoma protocols, so the goal for most patients is to give less treatment, not more; the minority with advanced or variant disease still need better options.
- Retrospective, and patients were treated on classical Hodgkin lymphoma protocols rather than with rituximab-based regimens now used by many centres.
- Trials spanned the 1990s to 2000s, so radiotherapy fields and chemotherapy were more intensive than current practice.
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