King Martin T, Donaldson Sarah S, Link Michael P, Natkunam Yasodha, Advani Ranjana H, Hoppe Richard T
Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California.
Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California.
Int J Radiat Oncol Biol Phys. 2015 May 1;92(1):67-75. doi: 10.1016/j.ijrobp.2015.02.001.
To analyze treatment outcomes for nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) at a single institution.
Patients with newly diagnosed NLPHL between 1996 and 2013 were reviewed retrospectively. Patients treated before 1996 were excluded because the majority received extended field radiation therapy (RT) alone.
Fifty-five patients (22 ≤ 21 years old) were identified. The median follow-up time was 6.8 years. Among 37 patients with limited-stage (I-II) disease, treatments included involved field RT at a median dose of 36 Gy (n=9), rituximab monotherapy (n=9), observation (n=3), and response-adaptive therapy (n=16), in which the RT dose was reduced from 25.5 Gy to 15 Gy or was eliminated based on interim imaging after chemotherapy. The 5-year progression-free survival (PFS) was 76.4% (95% confidence interval [CI], 63.1-92.4). Nine patients experienced progression, including 5 receiving rituximab, 2 undergoing observation, and 2 receiving response-adaptive therapy. Rituximab was associated with an inferior PFS compared with RT alone (P=.02). The difference in PFS between response-adaptive therapy and RT alone was not statistically significant (P=.39). Among 18 patients with advanced-stage (III-IV) disease, treatments included chemotherapy alone (n=3), combined modality therapy (CMT) (n=2), response-adaptive therapy (n=2), rituximab (n=7), and observation (n=4). The 5-year PFS was 29.9% (CI, 13.3-67.4). Twelve patients experienced progression, including 1 receiving chemotherapy, 1 receiving CMT, 6 receiving rituximab, and 4 undergoing observation. There was no significant PFS difference between rituximab and non-rituximab therapies (P=.19) within the caveat of small sample sizes. In the entire cohort, 9 patients (3 with limited disease, 6 with advanced disease) experienced large cell transformation (LCT). Seven patients died; of those, 5 died with LCT.
For limited disease, response-adaptive therapy demonstrated comparable outcomes with RT alone. Rituximab monotherapy resulted in inferior outcomes for limited disease and a high relapse rate for advanced disease.
分析单中心结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHL）的治疗结果。
回顾性分析1996年至2013年间新诊断的NLPHL患者。1996年前接受治疗的患者被排除，因为大多数患者仅接受扩大野放射治疗（RT）。
共纳入55例患者（年龄≤21岁者22例）。中位随访时间为6.8年。在37例局限期（I-II期）疾病患者中，治疗方法包括中位剂量为36 Gy的累及野RT（n = 9）、利妥昔单抗单药治疗（n = 9）、观察（n = 3）以及反应适应性治疗（n = 16），其中反应适应性治疗中RT剂量从25.5 Gy减至15 Gy或根据化疗后的中期影像学检查取消。5年无进展生存率（PFS）为76.4%（95%置信区间[CI]，63.1 - 92.4）。9例患者出现疾病进展，其中5例接受利妥昔单抗治疗，2例接受观察，2例接受反应适应性治疗。与单纯RT相比，利妥昔单抗治疗的PFS较差（P = 0.02）。反应适应性治疗与单纯RT的PFS差异无统计学意义（P = 0.39）。在18例晚期（III-IV期）疾病患者中，治疗方法包括单纯化疗（n = 3）、综合治疗（CMT）（n = 2）、反应适应性治疗（n = 2）、利妥昔单抗治疗（n = 7）以及观察（n = 4）。5年PFS为29.9%（CI，13.3 - 67.4）。12例患者出现疾病进展，其中1例接受化疗，1例接受CMT，6例接受利妥昔单抗治疗，4例接受观察。在样本量较小的情况下，利妥昔单抗与非利妥昔单抗治疗的PFS差异无统计学意义（P = 0.19）。在整个队列中，9例患者（局限期3例，晚期6例）发生大细胞转化（LCT）。7例患者死亡；其中5例死于LCT。
对于局限期疾病，反应适应性治疗与单纯RT疗效相当。利妥昔单抗单药治疗对局限期疾病疗效较差，对晚期疾病复发率高。
