Excellent PFS Observed With Upfront RT, RT Plus CT for Stage I-II NLPHL

Among patients with stage I-II nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), the use of upfront radiotherapy (RT) and RT plus chemotherapy (CT) is associated with an excellent progression-free survival (PFS; Blood. 2020;135[26]:2365-2374).

“[NLPHL] is an uncommon histologic variant, and the optimal treatment of stage I-II NLPHL is undefined,” wrote Michael S. Binkley, MD, Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, and colleagues.

To fill this gap in literature, Dr Binkley et al carried out a retrospective study of 559 patients (median age, 39 years) with stage I-II NLPHL who were diagnosed between 1995 and 2018 and who underwent all forms of management, including RT, CT, combined modality therapy (CMT; RT plus CT), observation after excision, rituximab plus RT, and rituximab alone.

The main end points of the study included PFS, freedom from transformation, and overall survival (OS) without statistical comparison between the treatment arms.

Follow-up lasted for a median of 5.5 years, and the 5-year PFS and OS rates across all patients were 87.1% and 98.3%, respectively.

RT administered alone was the most common form of management, given to 257 (46.0%) patients. CMT (n = 184; 32.9%), CT alone (n = 47; 8.4%), observation (n = 37; 6.6%), rituximab plus RT (n = 19; 3.4%), and rituximab alone (n = 15; 2.7%) followed suit.

Results indicated 5-year PFS rates of 91.1% after RT, 90.5% after CMT, 77.8% after CT, 73.5% after observation, 80.8% after rituximab plus RT, and 38.5% after rituximab alone.

“In the RT cohort, but not the CMT cohort, variant immunoarchitectural pattern and number of sites >2 were associated with worse PFS (P <.05),” Dr Binkley and co-investigators noted.

Furthermore, across the entire patient population, 21 (3.8%) had large-cell transformation, with a significantly higher transformation rate in those with variant immunoarchitectural pattern (P = .049) and >2 involved sites (P = .0006).

“OS for patients with stage I-II NLPHL was excellent after all treatments,” Dr Binkley and colleagues concluded.—Hina M. Porcelli