title: Nodular lymphocyte predominant Hodgkin lymphoma: a Lymphoma Study Association retrospective study.
abstract: Nodular lymphocyte predominant Hodgkin lymphoma represents a distinct entity from classical Hodgkin lymphoma. We conducted a retrospective study to investigate the management of patients with nodular lymphocyte predominant Hodgkin lymphoma. Clinical characteristics, treatment and outcome of adult patients with nodular lymphocyte predominant Hodgkin lymphoma were collected in Lymphoma Study Association centers. Progression-free survival (PFS) and overall survival (OS) were analyzed, and the competing risks formulation of a Cox regression model was used to control the effect of risk factors on relapse or death as competing events. Among 314 evaluable patients, 82.5% had early stage nodular lymphocyte predominant Hodgkin lymphoma. Initial management consisted in watchful waiting (36.3%), radiotherapy (20.1%), rituximab (8.9%), chemotherapy or immuno-chemotherapy (21.7%), combined modality treatment (12.7%), or radiotherapy plus rituximab (0.3%). With a median follow-up of 55.8 months, the 10-year PFS and OS estimates were 44.2% and 94.9%, respectively. The 4-year PFS estimates were 79.6% after radiotherapy, 77.0% after rituximab alone, 78.8% after chemotherapy or immuno-chemotherapy, and 93.9% after combined modality treatment. For the whole population, early treatment with chemotherapy or radiotherapy, but not rituximab alone (Hazard ratio 0.695 [0.320-1.512], P=0.3593) significantly reduced the risk of progression compared to watchful waiting (HR 0.388 [0.234-0.643], P=0.0002). Early treatment appears more beneficial compared to watchful waiting in terms of progression-free survival, but has no impact on overall survival. Radiotherapy in selected early stage nodular lymphocyte predominant Hodgkin lymphoma, and combined modality treatment, chemotherapy or immuno-chemotherapy for other patients, are the main options to treat adult patients with a curative intent.
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Lazarovici
authors.affiliation: Département de Biologie et Pathologie Médicales, Gustave Roussy, Villejuif, France.
authors.forename: Peggy
authors.initials: P
authors.lastname: Dartigues
authors.affiliation: Hopital Saint-Louis APHP, Université Paris Diderot, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Brice
authors.affiliation: Department of Hematology, IUC Toulouse Oncopole, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Obéric
authors.affiliation: Unité Hémopathies Lymphoïdes, AP-HP CHU Mondor, Créteil, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gaillard
authors.affiliation: Maladies du Sang, CHU Angers, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Hunault-Berger
authors.affiliation: Institut Paoli Calmettes, hematogy department, Marseilles, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Broussais-Guillaumot
authors.affiliation: Service d'hématologie et thérapie cellulaire, Centre Hospitalier Universitaire, Tours, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gyan
authors.affiliation: Department of Hematology, CHU Nancy-Brabois, Vandoeuvre, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Bologna
authors.affiliation: Department of Hematology, Leon Berard Cancer Center, Lyon, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Nicolas-Virelizier
authors.affiliation: Hematology Unit, CHU Limoges, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Touati
authors.affiliation: Department of Hematology, CHU Dijon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Casasnovas
authors.affiliation: AP-HP Hopital Necker, Paris, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Delarue
authors.affiliation: Service d'hématologie, centre hospitalier Annecy Genevois, Annecy, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Orsini-Piocelle
authors.affiliation: Hematology department, Centre Henri Becquerel, Rouen, France.
authors.forename: Aspasia
authors.initials: A
authors.lastname: Stamatoullas
authors.affiliation: Department of Hematology, Hopital Pitié Salpétrière AP-HP, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gabarre
authors.affiliation: Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France.
authors.forename: Luc-Matthieu
authors.initials: LM
authors.lastname: Fornecker
authors.affiliation: University Hospital of Nantes, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gastinne
authors.affiliation: Department of onco-hematology Centre Antoine Lacassagne-Comprehensive anticancer center, Nice, France.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Peyrade
authors.affiliation: Service d'hématologie clinique, Centre Hospitalier Saint Jean, Perpignan, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Roland
authors.affiliation: Department of Hematology, Lyon Sud Hospital, Pierre Benite, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bachy
authors.affiliation: Hematology, CHU Dinant Godinne, UCL Namur, Yvoir, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: André
authors.affiliation: Service d'Onco-Hématologie, CHU de Nice, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mounier
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France christophe.ferme@free.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Fermé
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006689:Hodgkin Disease / Q000145:classification / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate