Abstract
PurposeRadiation therapy (RT) is commonly used as definitive treatment for early-stage nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL). We evaluated the cause-specific survival (CSS), overall survival (OS), and second malignancy (SM) rates in patients with early-stage NLPHL treated with RT.Methods and MaterialsPatients with stage I-II NLPHL between 1988 and 2009 who underwent RT were selected from the Surveillance, Epidemiology and End Results database. Univariate analysis (UVA) for CSS and Os was performed using the Kaplan-Meier method and included age, gender, involved site, year of diagnosis, presence of B-symptoms, and extranodal involvement (ENI). Multivariable analysis (MVA) was performed using Cox Proportional Hazards modeling and included the above clinical variables. SM were classified as RT-related or non-RT-related. Freedom from SM and freedom from RT-related SM were determined using the Kaplan-Meier method.ResultsThe study cohort included 469 patients. Median age was 37 years. The most common involved sites were the head and neck (36%), axilla/arm (26%), and multiple lymph node regions (18%). Sixty-eight percent had stage I disease, 70% were male, 4% had ENI, and 7% had B-symptoms. Median follow-up was 6 years. Ten-year CSS and Os were 98% and 88%, respectively. On UVA, none of the covariates was associated with CSS. Increasing age (p<0.01) and female gender (p<0.01) were associated with worse Os. On MVA, older age (p<0.01), female gender (p=0.04), multiple regions of involvement (p=0.03), stage I disease (p=0.02), and presence of B-symptoms (p=0.02) were associated with worse Os. Ten-year freedom from SM and freedom from RT-related SM were 89% and 99%, respectively.ConclusionsThis is the largest series to evaluate the outcomes of stage I-II NLPHL patients treated with RT and found that this patient population has an excellent long-term prognosis and a low rate of RT-related second malignancies.
Highlights
The existence of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), a variant of Hodgkin’s lymphoma, has been known for over 30 years [1,2]
Stage I disease was more common (68%), the proportion of patients with Stage II disease increased over time (21% in 1988-1995 vs. 40% in 2006-2009; p=0.009)
There were no temporal trends in age (p=0.10), gender (p=0.53), primary site (p=0.21), extranodal involvement (p=0.86), and presence of B-symptoms (p=0.24)
Summary
The existence of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), a variant of Hodgkin’s lymphoma, has been known for over 30 years [1,2]. Because 80% of patients with NLPHL have early-stage (stage I-II) disease, the outcomes of this cohort are important to understand [4,5]. Prior studies have revealed that patients with NLPHL appear to have favorable disease outcomes and survival compared to their counterparts with classical Hodgkin’s lymphoma [4,7,8,9]. These studies have been limited by small cohorts and mostly single institution experiences
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