Historical outcomes for patients with stage IA NLPHL: Global NLPHL One Working Group retrospective analyses

Area of Science:

• Hematology
• Oncology
• Clinical Research

Background:

• Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a distinct subtype of Hodgkin lymphoma.
• Optimal management for stage IA NLPHL remains under investigation, particularly regarding the role of radiation therapy (RT) and systemic therapies.

Purpose of the Study:

• To evaluate treatment outcomes based on management type for patients with stage IA NLPHL.
• To determine the efficacy of different treatment modalities, including complete resection, observation, RT, rituximab, and chemotherapy (ABVD).

Main Methods:

• Retrospective analysis of 779 stage IA NLPHL patients from the Global NLPHL One Working Group (GLOW) database (1992-2021).
• Outcomes were compared between management groups: complete resection with observation vs. RT, and unresected disease treated with rituximab, RT, ABVD, or combination therapy.
• Progression-free survival (PFS) and overall survival (OS) were key endpoints.

Main Results:

• For completely resected stage IA NLPHL, RT significantly improved 6-year PFS (90.5%) compared to observation alone (65.5%).
• In unresected stage IA NLPHL, RT alone (89.6% 6-year PFS) and ABVD+RT (94.3% 6-year PFS) demonstrated superior outcomes.
• Rituximab alone (62.0% 6-year PFS) and ABVD alone (76.8% 6-year PFS) showed less durable responses.

Conclusions:

• Radiation therapy (RT) alone is likely sufficient for definitive treatment in stage IA NLPHL.
• Rituximab or ABVD monotherapy do not appear to provide durable responses for stage IA NLPHL.
• Chemotherapy (ABVD) did not demonstrate additional PFS benefit when combined with RT in this cohort.