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Published on: June 10, 2017
Lymphocyte-depleted classical Hodgkin's lymphoma: a comprehensive analysis from the German Hodgkin study group
Beate Klimm1, Jeremy Franklin, Harald Stein
1University Hospital of Cologne, Cologne, Germany.
Insights
Lymphocyte-depleted classical Hodgkin's lymphoma (LDCHL) presents with more risk factors and a poorer prognosis than other Hodgkin's lymphoma (HL) subtypes. However, modern dose-intense treatments may improve outcomes for LDCHL patients.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Hodgkin's lymphoma (HL) is a heterogeneous malignancy with distinct histologic subtypes.
- Lymphocyte-depleted classical Hodgkin's lymphoma (LDCHL) is a rare subtype with potentially different clinical behavior.
Purpose of the Study:
- To compare the clinical characteristics and treatment outcomes of LDCHL with other HL subtypes.
- To evaluate the impact of modern treatment strategies on LDCHL prognosis.
Main Methods:
- Retrospective analysis of 10,019 HL patients from German Hodgkin Study Group trials (HD4-HD15) with central pathology review.
- Identification and comparison of 84 LDCHL cases against other HL subtypes based on clinical presentation, risk factors, and treatment response.
Main Results:
- LDCHL patients more frequently presented with advanced disease (74% vs. 42%) and B symptoms (76% vs. 41%) compared to other HL subtypes.
- LDCHL showed significantly lower progression-free survival (71% vs. 85%) and overall survival (83% vs. 92%) at 5 years.
- In a subgroup receiving dose-intense chemotherapy, LDCHL patients (n=39) had similar outcomes to other HL subtypes (n=3,564).
Conclusions:
- LDCHL is characterized by more clinical risk factors at diagnosis and a poorer prognosis compared to other HL subtypes.
- Modern dose-intense treatment strategies appear to be effective in improving outcomes for patients with LDCHL.
Purpose:
To investigate the clinical characteristics and treatment outcome of patients with lymphocyte-depleted classical Hodgkin's lymphoma (LDCHL) compared with other histologic subtypes of Hodgkin's lymphoma (HL).
Patients And Methods:
From a total of 12,155 evaluable patients with biopsy-proven HL treated within the German Hodgkin Study Group trials HD4 to HD15, 10,019 patients underwent central expert pathology review. Eighty-four patients with LDCHL (< 1%) were identified and confirmed. The median follow-up time was 67 months.
Results:
Patients with LDCHL, compared with patients with other histologic subtypes, presented more often with advanced disease (74% v 42%, respectively; P < .001) and "B" symptoms (76% v 41%, respectively; P < .001). Other risk factors were also more frequent in patients with LDCHL. Complete remission or unconfirmed complete remission was achieved in 82% of patients with LDCHL compared with 93% of patients with other HL subtypes (P < .001), and more patients with LDCHL had progressive disease. At 5 years, progression-free survival (PFS) and overall survival (OS) were significantly lower in patients with LDCHL compared with patients with other HL subtypes (PFS, 71% v 85%, respectively; P < .001; OS, 83% v 92%, respectively; P = .0018). However, when analyzing the subgroup of patients who underwent treatment with intensified or dose-dense bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, patients with LDCHL (n = 39) had similar outcomes when compared with patients with other subtypes of HL (n = 3,564; P = .61).
Conclusion:
LDCHL has a different pattern from other HL subtypes with more clinical risk factors at initial diagnosis and significantly poorer prognosis. Patients with LDCHL should be treated with modern dose-intense treatment strategies.
