Encouraging activity for R-CHOP in advanced stage nodular lymphocyte–predominant Hodgkin lymphoma Journal Article

Authors: Fanale, M. A.; Cheah, C. Y.; Rich, A.; Medeiros, L. J.; Lai, C. M.; Oki, Y.; Romaguera, J. E.; Fayad, L. E.; Hagemeister, F. B.; Samaniego, F.; Rodriguez, M. A.; Neelapu, S. S.; Lee, H. J.; Nastoupil, L.; Fowler, N. H.; Turturro, F.; Westin, J. R.; Wang, M. L.; McLaughlin, P.; Pinnix, C. C.; Milgrom, S. A.; Dabaja, B.; Horowitz, S. B.; Younes, A.
Article Title: Encouraging activity for R-CHOP in advanced stage nodular lymphocyte–predominant Hodgkin lymphoma
Abstract: Nodular lymphocyte Hodgkin lymphoma (NLPHL) is a rare disease for which the optimal therapy is unknown. We hypothesized that rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) could decrease rates of relapse and transformation. We retrospectively reviewed patients with NLPHL diagnosed between 1995 and 2015 confirmed by central pathologic review. Fifty-nine had sufficient treatment and follow-up data for analysis. We described progression-free survival (PFS), overall survival (OS), and histologic transformation according to treatment strategy and explored prognostic factors for PFS and OS. The median age at diagnosis was 41 years; 75% were male, and 61% had a typical growth pattern. Twenty-seven patients were treated with R-CHOP with an overall response rate of 100% (complete responses 89%). The median follow-up was 6.7 years, and the estimated 5- and 10-year PFS rates for patients treated with R-CHOP were 88.5% (95% confidence interval [CI], 68.4% to 96.1%) and 59.3 (95% CI, 25.3% to 89.1%), respectively. Excluding patients with histologic transformation at diagnosis, the 5-year cumulative incidence of histologic transformation was 2% (95% CI, 87% to 100%). No patient treated with R-CHOP experienced transformation. A high-risk score from the German Hodgkin Study Group was adversely prognostic for OS (P 5 .036), whereas male sex and splenic involvement were adversely prognostic for PFS (P 5 .006 and .002, respectively) but not OS. Our data support a potential role for R-CHOP in patients with NLPHL. Larger prospective trials are needed to define the optimal chemotherapy regimen. © 2017 by The American Society of Hematology.
Keywords: adolescent; adult; cancer survival; aged; disease-free survival; middle aged; survival rate; retrospective studies; major clinical study; overall survival; prednisone; clinical trial; mortality; doxorubicin; advanced cancer; cancer combination chemotherapy; monotherapy; cancer patient; cancer radiotherapy; disease free survival; rituximab; cancer staging; outcome assessment; follow up; follow-up studies; antineoplastic agent; dacarbazine; progression free survival; multiple cycle treatment; antineoplastic combined chemotherapy protocols; radiotherapy dosage; incidence; cyclophosphamide; vincristine; retrospective study; histology; procarbazine; vinblastine; hodgkin disease; time factors; monoclonal antibody; b cell lymphoma; mitoxantrone; bleomycin; immunophenotyping; nodular lymphocyte predominant hodgkin lymphoma; time factor; diffuse large b cell lymphoma; antibodies, monoclonal, murine-derived; cancer prognosis; humans; human; male; female; priority journal; article; r-chop protocol; t cell rich b cell lymphoma
Journal Title: Blood
Volume: 130
Issue: 4
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2017-07-27
Start Page: 472
End Page: 477
Language: English
DOI: 10.1182/blood-2017-02-766121
PUBMED: 28522441
PROVIDER: scopus
PMCID: PMC5578726
Notes: Article -- Export Date: 5 September 2017 -- Source: Scopus
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MSK Authors
  1. Anas Younes
    250 Younes