Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Center for Molecular Medicine, Else-Kröner Forschungskolleg Clonal Evolution in Cancer and Department I for Medicine, University of Cologne, Cologne, Germany.
Blood. 2019 May 16;133(20):2121-2129. doi: 10.1182/blood-2018-10-877761. Epub 2019 Feb 15.
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of lymphoma that, like other Hodgkin lymphomas, has historically been treated aggressively. However, in most cases, NLPHL has an indolent course, which raises the question of to what extent these patients require aggressive upfront treatment. We describe the management and outcomes of consecutive NLPHL patients diagnosed at Memorial Sloan Kettering Cancer Center (MSK), with a focus on evaluating active surveillance. All patients aged 16 years or older diagnosed and followed at MSK between 1974 and 2016 were included. Treatment outcomes were compared between management with active surveillance and other strategies. We identified 163 consecutive patients who were treated with radiotherapy alone (46%), active surveillance (23%), chemotherapy (16%), combined modality (12%), or rituximab monotherapy (4%). Median follow-up was 69 months. Five-year progression-free survival (PFS), second PFS (PFS2), and overall survival (OS) estimates were 85% (95% confidence interval [CI], 78-90), 97% (95% CI, 92-99), and 99% (95% CI, 95-100), respectively. Only 1 of 7 deaths was lymphoma related. Patients managed with active surveillance had slightly shorter PFS than those receiving any active treatment, with 5-year PFS of 77% (95% CI, 56-89) vs 87% (95% CI, 79-92; = .017). This difference did not translate into better PFS2 or OS. Only 10 patients managed with active surveillance (27%) eventually required treatment, after a median of 61 months, and none died. NLPHL has an excellent prognosis. Within the limitations of a retrospective analysis, active surveillance is a viable initial management strategy for selected NLPHL patients.
结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHL）是一种罕见的淋巴瘤亚型，与其他霍奇金淋巴瘤一样，历史上一直采用积极的治疗方法。然而，在大多数情况下，NLPHL 呈惰性病程，这就提出了一个问题，即这些患者在多大程度上需要进行积极的初始治疗。我们描述了在纪念斯隆凯特琳癌症中心（MSK）诊断的连续 NLPHL 患者的管理和结果，重点评估了主动监测。所有年龄在 16 岁及以上、1974 年至 2016 年在 MSK 诊断和随访的患者均被纳入研究。比较了主动监测与其他策略管理的治疗结果。我们共确定了 163 例连续患者，他们接受了单纯放疗（46%）、主动监测（23%）、化疗（16%）、联合治疗（12%）或利妥昔单抗单药治疗（4%）。中位随访时间为 69 个月。5 年无进展生存率（PFS）、第二次 PFS（PFS2）和总生存率（OS）估计值分别为 85%（95%CI，78-90）、97%（95%CI，92-99）和 99%（95%CI，95-100）。仅 1 例死亡与淋巴瘤相关。接受主动监测的患者 PFS 略短于接受任何积极治疗的患者，5 年 PFS 为 77%（95%CI，56-89）vs 87%（95%CI，79-92；P=.017）。但这一差异并未转化为更好的 PFS2 或 OS。仅 10 例接受主动监测（27%）的患者在中位时间 61 个月后最终需要治疗，且无一例死亡。NLPHL 的预后极好。在回顾性分析的局限性内，主动监测是一种可行的 NLPHL 患者初始管理策略。
