title: High-dose chemotherapy and autologous stem cell  transplantation for relapsed or refractory nodular lymphocyte  predominant Hodgkin lymphoma.
abstract: Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a distinct subtype of Hodgkin lymphoma. We report our results of relapsed/refractory NLPHL patients who received high-dose chemotherapy and autogenic stem cell transplantation (HDC auto-SCT). Seventeen NLPHL patients received HDC auto-SCT (1996–2014): male 14 and female 3, with median age at diagnosis of 22 years, at HDC auto-SCT 28 years (15–58 years). At the time of relapse/progression, 13 (76 %) had NLPHL and 4 (24 %) had transformed diffuse large B cell lymphoma. The reason for HDC auto-SCT was refractory NLPHL in 12 patients and relapsed in 5 patients. Salvage chemotherapy was etoposide, methylprednisolone, cisplatinum, and Ara-C (ESHAP); eight patients also received rituximab with ESHAP. HDC was carmustine, etoposide, cytarabine, and melphalan (BEAM). Post-auto-SCT, complete remission was achieved in 14 (82 %), partial remission in 1 (6 %), and progressive disease in 2 (12 %) patients. The median follow-up is 63 months from auto-SCT (6–124 months). Of the nine patients who received only ESHAP, four had post-auto-SCT events versus no event in all eight patients who received rituximab+ESHAP. Kaplan–Meier estimates of 5-year event-free survival for the whole group is 76 %: rituximab+salvage (100 %) versus salvage alone (56 %), P=0.041. Overall survival is 94 %: 100 versus 89 %, respectively, P=not significant (NS). Even in refractory NLPHL patients, long-term disease-free survival is possible after HDC auto-SCT. Post-auto-SCT relapse or progression can still be managed with chemo/chemo+immunotherapy/ radiation. These encouraging results of rituximab in salvage setting should be explored further in a clinical trial setting for this patient population.
authors.affiliation: Oncology Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Saudi Arabia. sakhtar@kfshrc.edu.sa.
authors.forename: S
authors.initials: S
authors.lastname: Akhtar
authors.affiliation: Oncology Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Saudi Arabia.
authors.forename: T A M
authors.initials: TAM
authors.lastname: Elhassan
authors.affiliation: Oncology Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Saudi Arabia.|Clinical Oncology Center, Cairo University, Giza, Egypt.
authors.forename: W
authors.initials: W
authors.lastname: Edesa
authors.affiliation: Oncology Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Saudi Arabia.
authors.forename: M S
authors.initials: MS
authors.lastname: Rauf
authors.affiliation: Oncology Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Saudi Arabia.
authors.forename: M N
authors.initials: MN
authors.lastname: Zahir
authors.affiliation: Oncology Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Saudi Arabia.
authors.forename: I
authors.initials: I
authors.lastname: Maghfoor
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014182:Transplantation, Autologous / Q000379:methods; D055815:Young Adult
chemical_list: D003561:Cytarabine; D005047:Etoposide; D002945:Cisplatin; D008775:Methylprednisolone