title: Characteristics and outcomes of patients with nodular lymphocyte-predominant Hodgkin lymphoma versus those with classical Hodgkin lymphoma: a population-based analysis.
abstract: OBJECTIVE
  Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is rare, comprising approximately 5% of all Hodgkin lymphoma (HL) cases. Patients with NLPHL tend to have better prognoses than those with classical HL (CHL). Our goal was to assess differences in survival between NLPHL and CHL patients, controlling for differences in patient and disease characteristics.
  
  
  METHODS
  Using data from the population-based Surveillance, Epidemiology and End Results (SEER) cancer registry program, we identified patients diagnosed with pathologically confirmed HL between 1988 and 2010.
  
  
  RESULTS
  We identified 1,162 patients with NLPHL and 29,083 patients with CHL. With a median follow-up of 7 years, 5- and 10-year overall survival (OS) rates were 91% and 83% for NLPHL, respectively, and 81% and 74% for CHL, respectively. After adjusting for all available characteristics, NLPHL (vs CHL) was associated with higher OS (hazard ratio [HR]: 0.62, P<.01) and disease-specific survival (DSS; HR: 0.48, P<.01). The male predominance of NLPHL, compared to CHL, as well as the more favorable prognostic features in NLPHL patients are most pronounced in NLPHL patients <20 years old. Among all NLPHL patients, younger patients were less likely to receive radiation, and radiation use has declined by 40% for all patients from 1988 to 2010. Receipt of radiation was associated with better OS (HR: 0.64, P=.03) and DSS (HR: 0.45, P=.01) in NLPHL patients after controlling for available baseline characteristics. Other factors associated with OS and DSS in NLPHL patients are younger age and early stage.
  
  
  CONCLUSIONS
  Our results in a large population dataset demonstrated that NLPHL patients have improved prognosis compared to CHL patients, even after accounting for stage and baseline characteristics. Use of radiation is declining among NLPHL patients despite an association in this series between radiation and better DSS and OS. Unique treatment strategies for NLPHL are warranted in both early and advanced stage disease.
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Naamit K
authors: NK
authors: Gerber
authors: Department of Epidemiology and Biostatistics, Health Outcomes Research Group, New York, New York.
authors: Coral L
authors: CL
authors: Atoria
authors: Department of Epidemiology and Biostatistics, Health Outcomes Research Group, New York, New York.
authors: Elena B
authors: EB
authors: Elkin
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: yahalomj@mskcc.org.
authors: Joachim
authors: J
authors: Yahalom
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018572:Disease-Free Survival; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000706:statistics & numerical data; D012044:Regression Analysis; D018426:SEER Program; D012737:Sex Factors; D015996:Survival Rate; D055815:Young Adult