Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma

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

Research output: Contribution to journalArticle

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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 5 .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.

Original languageEnglish (US)
Pages (from-to)2121-2129
Number of pages9
JournalBlood
Volume133
Issue number20
DOIs
StatePublished - May 16 2019

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Lymphocytes
Hodgkin Disease
Disease-Free Survival
Confidence Intervals
Lymphoma
Chemotherapy
Radiotherapy
Survival
Therapeutics
Drug Therapy
Neoplasms

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Borchmann, S., Joffe, E., Moskowitz, C., Zelenetz, A. D., Noy, A., Portlock, C. S., ... Straus, D. J. (2019). Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma. Blood, 133(20), 2121-2129. https://doi.org/10.1182/blood-2018-10-877761

Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma. / Borchmann, Sven; Joffe, Erel; Moskowitz, Craig; Zelenetz, Andrew D.; Noy, Ariela; Portlock, Carol S.; Gerecitano, John F.; Batlevi, Connie L.; Caron, Philip C.; Drullinsky, Pamela; Hamilton, Audrey; Hamlin, Paul A.; Horwitz, Steven M.; Kumar, Anita; Matasar, Matthew J.; Moskowitz, Alison J.; Owens, Colette N.; Lia Palomba, M.; Younes, Anas; Straus, David J.

In: Blood, Vol. 133, No. 20, 16.05.2019, p. 2121-2129.

Research output: Contribution to journalArticle

Borchmann, S, Joffe, E, Moskowitz, C, Zelenetz, AD, Noy, A, Portlock, CS, Gerecitano, JF, Batlevi, CL, Caron, PC, Drullinsky, P, Hamilton, A, Hamlin, PA, Horwitz, SM, Kumar, A, Matasar, MJ, Moskowitz, AJ, Owens, CN, Lia Palomba, M, Younes, A & Straus, DJ 2019, 'Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma', Blood, vol. 133, no. 20, pp. 2121-2129. https://doi.org/10.1182/blood-2018-10-877761
Borchmann S, Joffe E, Moskowitz C, Zelenetz AD, Noy A, Portlock CS et al. Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma. Blood. 2019 May 16;133(20):2121-2129. https://doi.org/10.1182/blood-2018-10-877761
Borchmann, Sven ; Joffe, Erel ; Moskowitz, Craig ; Zelenetz, Andrew D. ; Noy, Ariela ; Portlock, Carol S. ; Gerecitano, John F. ; Batlevi, Connie L. ; Caron, Philip C. ; Drullinsky, Pamela ; Hamilton, Audrey ; Hamlin, Paul A. ; Horwitz, Steven M. ; Kumar, Anita ; Matasar, Matthew J. ; Moskowitz, Alison J. ; Owens, Colette N. ; Lia Palomba, M. ; Younes, Anas ; Straus, David J. / Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma. In: Blood. 2019 ; Vol. 133, No. 20. pp. 2121-2129.
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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 5 .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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AU - Noy, Ariela

AU - Portlock, Carol S.

AU - Gerecitano, John F.

AU - Batlevi, Connie L.

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AU - Drullinsky, Pamela

AU - Hamilton, Audrey

AU - Hamlin, Paul A.

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AU - Straus, David J.

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N2 - 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 5 .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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