Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma Journal Article


Authors: Borchmann, S.; Joffe, E.; Moskowitz, C. H.; Zelenetz, A. D.; Noy, A.; Portlock, C. S.; Gerecitano, J. F.; Batlevi, C. L.; Caron, P. C.; Drullinsky, P.; Hamilton, A.; Hamlin, P. A. Jr; Horwitz, S. M.; Kumar, A.; Matasar, M. J.; Moskowitz, A. J.; Owens, C. N.; Lia Palomba, M.; Younes, A.; Straus, D. J.
Article Title: Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma
Abstract: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of lymphoma that, like other Hodgkin lymphomas, has historically been treated aggressively. However, in most cases, NLPHL has an indolent course, which raises the question of to what extent these patients require aggressive upfront treatment. We describe the management and outcomes of consecutive NLPHL patients diagnosed at Memorial Sloan Kettering Cancer Center (MSK), with a focus on evaluating active surveillance. All patients aged 16 years or older diagnosed and followed at MSK between 1974 and 2016 were included. Treatment outcomes were compared between management with active surveillance and other strategies. We identified 163 consecutive patients who were treated with radiotherapy alone (46%), active surveillance (23%), chemotherapy (16%), combined modality (12%), or rituximab monotherapy (4%). Median follow-up was 69 months. Five-year progression-free survival (PFS), second PFS (PFS2), and overall survival (OS) estimates were 85% (95% confidence interval [CI], 78-90), 97% (95% CI, 92-99), and 99% (95% CI, 95-100), respectively. Only 1 of 7 deaths was lymphoma related. Patients managed with active surveillance had slightly shorter PFS than those receiving any active treatment, with 5-year PFS of 77% (95% CI, 56-89) vs 87% (95% CI, 79-92; P 5 .017). This difference did not translate into better PFS2 or OS. Only 10 patients managed with active surveillance (27%) eventually required treatment, after a median of 61 months, and none died. NLPHL has an excellent prognosis. Within the limitations of a retrospective analysis, active surveillance is a viable initial management strategy for selected NLPHL patients. © 2019 by The American Society of Hematology
Journal Title: Blood
Volume: 133
Issue: 20
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2019-05-16
Start Page: 2121
End Page: 2129
Language: English
DOI: 10.1182/blood-2018-10-877761
PUBMED: 30770396
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 July 2019 -- Source: Scopus
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MSK Authors
  1. Carol Portlock
    198 Portlock
  2. Craig Moskowitz
    388 Moskowitz
  3. Ariela Noy
    226 Noy
  4. Maria Lia Palomba
    165 Palomba
  5. Steven M Horwitz
    412 Horwitz
  6. Andrew D Zelenetz
    600 Zelenetz
  7. Alison Moskowitz
    179 Moskowitz
  8. Paul Hamlin
    186 Hamlin
  9. Matthew J Matasar
    151 Matasar
  10. Philip C Caron
    41 Caron
  11. David J Straus
    247 Straus
  12. Anita Kumar
    67 Kumar
  13. Connie Wing-Ching Lee
    69 Lee
  14. Anas Younes
    248 Younes
  15. Colette Ngozi Owens
    9 Owens
  16. Erel Joffe
    10 Joffe