title: Large B-cell transformation in nodular lymphocyte-predominant Hodgkin lymphoma: 40-year experience from a single institution.
abstract: A number of reports have shown a propensity of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) to transform into diffuse large B-cell lymphoma (DLBCL). Long-term data on the incidence and outcomes of transformed NLPHL are lacking. A comprehensive analysis of the actively maintained Mayo Clinic Lymphoma Database was performed. Between 1970 and 2011, 222 consecutive adult patients with new untreated NLPHL were identified. Median age at diagnosis was 40 years, and 146 (66%) were males. The median follow-up was 16 years. Seventeen patients (7.6%) developed a transformation to DLBCL. The median time to transformation was 35 months (range, 6-268 months). Based on the observed 17 transformations during 2304 patient-years of follow-up, the rate of transformation was 0.74 per 100 patient-years. In a multivariate analysis, use of any prior chemotherapy ( ITALIC! P= .04) and splenic involvement ( ITALIC! P= .03) were significantly associated with increased risk of transformation. The 5-year overall survival (OS) in those with transformed disease was 76.4%, and transformation did not adversely affect OS when compared with patients who did not experience transformation. In this large single-institution cohort with long-term follow-up, the risk of transformation was lower than that observed in other low-grade lymphomas.
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Saad Sirop
authors.identifier: http://orcid.org/0000-0003-2767-3830
authors.initials: SS
authors.lastname: Kenderian
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.affiliation: Department of Laboratory Medicine and Pathology, and.
authors.forename: William R
authors.initials: WR
authors.lastname: Macon
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Kay M
authors.initials: KM
authors.lastname: Ristow
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ansell
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Colgan
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Johnston
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Svetomir N
authors.initials: SN
authors.lastname: Markovic
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Ivana N
authors.initials: IN
authors.lastname: Micallef
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Porrata
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: James A
authors.initials: JA
authors.lastname: Martenson
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.affiliation: Division of Hematology, Department of Internal Medicine.
authors.forename: Grzegorz S
authors.initials: GS
authors.lastname: Nowakowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001402:B-Lymphocytes / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D055815:Young Adult
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