title: Differences in outcome of patients with syncytial variant Hodgkin lymphoma compared with typical nodular sclerosis Hodgkin lymphoma.
abstract: BACKGROUND
  Nodular sclerosis Hodgkin lymphoma (NS-HL) is the most common subtype of HL and usually has a good prognosis. A variant of NS, the syncytial variant (SV) has well-established histopathologic features but little is known about its clinical behavior. Small case series have suggested that SV patients present with advanced disease and have a comparatively aggressive course. The objective of this study was to determine the clinical characteristics and outcome of SV patients.
  
  
  METHODS
  A total of 167 adult patients with NS-HL including 43 patients with SV and 124 patients with typical NS (t-NS) were included in our analysis following institutional review board (IRB) approval. The Kaplan-Meier method was used to calculate the progression-free survival (PFS) and overall survival (OS). Log-rank test was used to determine the differences in survival.
  
  
  RESULTS
  Of the 167 patients, 43 were confirmed as SV based on morphology and immunophenotype. Doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) was the most frequent induction regimen administered in 91% of all patients. The rate of complete response (CR) in the SV group was 74%versus87% in the t-NS group (p= 0.05). At 49 months follow up, the PFS was 17 months in the SV group and not reached in the t-NS group [p< 0.0001; hazard ratio (HR) = 3.695; 95% confidence interval (CI) = 3.0, 11.07]. The median OS was not reached in both groups (p= 0.32).
  
  
  CONCLUSIONS
  Our results show that SV histology represents a poor risk group with lower CR rate and shorter PFS and this should be considered in the risk stratification of classical HL patients.
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Tarsheen
authors.initials: T
authors.lastname: Sethi
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Van
authors.initials: V
authors.lastname: Nguyen
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Shaoying
authors.initials: S
authors.lastname: Li
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Morgan
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: John
authors.initials: J
authors.lastname: Greer
authors.affiliation: Vanderbilt University, 3927 The Vanderbilt Clinic, 1301 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Nishitha
authors.initials: N
authors.lastname: Reddy
keywords: Hodgkin lymphoma; nodular sclerosis; outcome; syncytial variant