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Hodgkin's disease with lymphocyte predominance: long-term results based on current histopathologic criteria
C S Ha1, V Kavadi, M A Dimopoulos
1Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Insights
This study on lymphocyte-predominant Hodgkin's disease found no significant survival differences between nodular and diffuse subtypes. Treatment strategies for LPHD may not require deviation from classical Hodgkin's disease protocols.
Area of Science:
- Oncology
- Hematology
- Pathology
Background:
- Lymphocyte-predominant Hodgkin's disease (LPHD) is a subtype of Hodgkin's disease.
- Understanding LPHD's disease course, treatment, and prognostic factors is crucial for patient management.
- Histologic patterns, specifically nodular and diffuse, may influence LPHD outcomes.
Purpose of the Study:
- To define the disease course, therapeutic strategies, relapse patterns, and mortality in LPHD patients.
- To assess prognostic factors, including nodular and diffuse histologic patterns, in LPHD.
- To compare outcomes between nodular and diffuse LPHD subtypes.
Main Methods:
- Retrospective review of 70 previously untreated LPHD patients at UTMDACC (1960-1992).
- Analysis of clinical and histopathologic characteristics, treatment, survival, relapse patterns, and causes of death.
- Assessment of nodular vs. diffuse LPHD subtypes and their impact on outcomes.
Main Results:
- Majority (83%) had nodular LPHD; clinical characteristics were similar between subtypes.
- 19% of patients relapsed, with earlier relapses in diffuse subtype and later in nodular subtype.
- No statistically significant difference in relapse-free survival or overall survival between nodular and diffuse LPHD subtypes was detected.
Conclusions:
- LPHD typically presents as localized, asymptomatic disease, and laparotomy is unnecessary with negative lymphograms.
- Despite different relapse timing, nodular and diffuse LPHD subtypes showed similar survival outcomes.
- Current evidence does not support treating LPHD differently from classical Hodgkin's disease.
Purpose:
To define the disease course, therapeutic strategies, patterns and rates of relapse and causes of death for patients with Hodgkin's disease with lymphocyte predominance (LPHD) and to assess prognostic factors including nodular and diffuse histologic patterns.
Patients And Methods:
The records of all previously untreated patients with LPHD who received initial treatment at the University of Texas M. D. Anderson Cancer Center (UTMDACC) from 1960 through 1992 were reviewed. Clinical and histopathologic characteristics, specifically nodular and diffuse LPHD, and treatment groups were assessed by overall and relapse-free survival, patterns of relapse, and causes of death.
Results:
Of 70 patients, 58 (83%) had nodular LPHD and 12 (17%) had a diffuse pattern: clinical characteristics were similar between the two subtypes. The median age of all patients was 25 years, 79% were male, 96% presented with stage I or II disease and 93% were free of B symptoms. Laparotomy (23 patients) failed to upstage any patient with a negative lymphogram. With a median follow-up of 12.3 years for alive patients, 19 (27%) patients have relapsed. All 3 relapses among the patients with diffuse subtype occurred within 3 years while 9 of 16 relapses occurred after 5 years with nodular subtype. However, we did not detect any statistically significant difference in relapse free survival or survival between the subtypes in our patient population. There was some suggestion that patients aged 40 and older experienced shorter survival; no other pretreatment characteristics were noted to be associated with relapse free survival or survival. Though there were no relapses within the radiation fields, no effect of extent of radiation therapy on relapse rate was observed. Thirteen (19%) patients have died, 6 (8.6%) of whom succumbed to LPHD. Two patients developed diffuse large cell lymphoma.
Conclusions:
Patients with LPHD usually present with localized and asymptomatic disease. Laparotomy is unnecessary if the lymphogram is negative. Nodular histology occurred in the majority of patients. Though all relapses from diffuse subtype occurred within 3 years in contrast to some late relapses observed for nodular subtype, there was no statistically significant difference in relapse free survival or survival between the subtypes. The extent of irradiation had no effect on relapse free survival or survival. We could not find any evidence that LPHD should be treated any different from the classical Hodgkin's disease at this point despite suggestions that it be classified as a non-Hodgkin's B-cell lymphoma.