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Published on: June 10, 2017
Lymphocyte-predominant and classical Hodgkin's lymphoma--comparison of outcomes
Lucia Nogová1, Thorsten Reineke, Andreas Josting
1Clinic I for Internal Medicine, University Hospital Cologne, Cologne, Germany. lucia.nogova@uk-koeln.de
Insights
Lymphocyte-predominant Hodgkin lymphoma (LPHL) and classical Hodgkin lymphoma (cHL) share similar outcomes, including remission, relapse, and survival rates, despite differences in disease stage and symptoms. This study analyzed 8298 patients to compare these two subtypes of Hodgkin lymphoma.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- Lymphocyte-predominant Hodgkin's lymphoma (LPHL) presents distinct histological and clinical features compared to classical Hodgkin's lymphoma (cHL).
- Standard Hodgkin's lymphoma (HL) protocols achieve over 95% complete remission (CR) in LPHL patients.
- Previous analyses suggested potential differences in relapse rates, survival, and freedom from treatment failure (FFTF) between LPHL and cHL.
Purpose of the Study:
- To comprehensively compare patient characteristics and treatment outcomes between LPHL and cHL.
- To evaluate differences in disease progression, relapse, secondary malignancies, and survival.
- To provide a detailed analysis of LPHL cases within a large Hodgkin lymphoma patient database.
Main Methods:
- Retrospective analysis of 8298 Hodgkin lymphoma (HL) patients from GHSG trials (HD4-HD12).
- Comparison of 394 LPHL patients with 7904 cHL patients.
- Analysis included disease stage, B symptoms, complete remission (CR/CRu), progressive disease (PD), relapse rates, secondary malignancies, overall survival (OS), and freedom from treatment failure (FFTF).
Main Results:
- LPHL patients were more frequently diagnosed in early stages (63%) with fewer B symptoms (9%) compared to cHL patients (22% early stage, 40% B symptoms).
- Complete remission rates (CR/CRu) were high and similar for both groups across all stages (e.g., 79% LPHL vs. 75% cHL in advanced stages).
- Progressive disease (PD) was significantly lower in LPHL (0.3%) vs. cHL (3.7%). Relapse rates (8.1% vs. 7.9%), secondary malignancies (2.5% vs. 3.7%), mortality (4.3% vs. 8.8%), FFTF (92% vs. 84%), and OS (96% vs. 92%) were comparable or favored LPHL.
Conclusions:
- Classical Hodgkin lymphoma (cHL) patients more commonly present with advanced stages and B symptoms than lymphocyte-predominant Hodgkin lymphoma (LPHL) patients.
- Treatment outcomes, including CR/CRu, PD, and mortality, show no significant differences between LPHL and cHL.
- Surprisingly, no significant differences were observed in relapse patterns between LPHL and cHL patients, suggesting similar long-term prognoses.
Introduction:
Lymphocyte predominant Hodgkin's lymphoma (LPHL) differs in histological and clinical presentation from classical Hodgkin's lymphoma (cHL). Treatment of LPHL patients using standard Hodgkin's lymphoma (HL) protocols leads to complete remission (CR) in more than 95% of patients. However, differences in terms of relapse rates, survival and freedom from treatment failure (FFTF) between LPHL and cHL patients were suggested by a recent intergroup analysis. To obtain a more comprehensive picture, we reviewed all LPHL-cases registered in the GHSG database and compared patient characteristics and treatment outcome with cHL patients.
Patients And Methods:
We retrospectively analyzed 8298 HL patients treated within the GHSG trials (HD4-HD12): 394 LPHL patients and 7904 cHL patients. From 394 LPHL patients 63% were in early stage, 16% in intermediate and 21% in advanced stage of disease. Of the 7904 cHL patients analyzed, 22% were in early, 39% in intermediate and 39% in advanced stages. About 9% of LPHL patients had B symptoms compared to 40% in cHL patients.
Results:
About 91% LPHL vs. 86% cHL patients in early stages, 86% vs. 83% in intermediate and 79% vs. 75% in advanced stages reached CR/CRu. Additional analysis for LPHL IA patients showed 98% CR/CRu after extended field, 100% after involved field (IF) and 98% CR/CRu after combined modality treatment. About 0.3% LPHL patients developed progressive disease (PD) compared to 3.7% cHL patients. The relapse rate of LPHL patients was very similar to cHL (8.1% vs. 7.9%). There were 2.5% secondary malignancies in LPHL and 3.7% in cHL patients. About 4.3% LPHL patients and 8.8% cHL patients died. The FFTF rates for LPHL and cHL patients at a median observation of 41 or 48 months were 92% and 84%, respectively. The OS for LPHL and cHL patients was 96% and 92%, respectively.
Conclusion:
The cHL patients present more frequently with advanced stages and B symptoms compared to LPHL patients. There was no difference in treatment outcome in terms of CR/CRu, PD and mortality between LPHL and HL. Surprisingly, there were also no differences in patients with relapse.
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