Large B-cell transformation in nodular lymphocyte-predominant Hodgkin lymphoma: 40-year experience from a single institution - PubMed (original) (raw)

. 2016 Apr 21;127(16):1960-6.

doi: 10.1182/blood-2015-08-665505. Epub 2016 Feb 2.

Thomas M Habermann 1, William R Macon 2, Kay M Ristow 1, Stephen M Ansell 1, Joseph P Colgan 1, Patrick B Johnston 1, David J Inwards 1, Svetomir N Markovic 1, Ivana N Micallef 1, Carrie A Thompson 1, Luis F Porrata 1, James A Martenson 3, Thomas E Witzig 1, Grzegorz S Nowakowski 1

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Large B-cell transformation in nodular lymphocyte-predominant Hodgkin lymphoma: 40-year experience from a single institution

Saad Sirop Kenderian et al. Blood. 2016.

Abstract

A number of reports have shown a propensity of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) to transform into diffuse large B-cell lymphoma (DLBCL). Long-term data on the incidence and outcomes of transformed NLPHL are lacking. A comprehensive analysis of the actively maintained Mayo Clinic Lymphoma Database was performed. Between 1970 and 2011, 222 consecutive adult patients with new untreated NLPHL were identified. Median age at diagnosis was 40 years, and 146 (66%) were males. The median follow-up was 16 years. Seventeen patients (7.6%) developed a transformation to DLBCL. The median time to transformation was 35 months (range, 6-268 months). Based on the observed 17 transformations during 2304 patient-years of follow-up, the rate of transformation was 0.74 per 100 patient-years. In a multivariate analysis, use of any prior chemotherapy ( ITALIC! P= .04) and splenic involvement ( ITALIC! P= .03) were significantly associated with increased risk of transformation. The 5-year overall survival (OS) in those with transformed disease was 76.4%, and transformation did not adversely affect OS when compared with patients who did not experience transformation. In this large single-institution cohort with long-term follow-up, the risk of transformation was lower than that observed in other low-grade lymphomas.

© 2016 by The American Society of Hematology.

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Figures

Figure 1

Figure 1

Changes in initial management strategies of NLPHL across 4 decades in 1 institution. CT, chemotherapy; CRT, chemoradiation therapy.

Figure 2

Figure 2

Freedom from transformation into DLBCL in 222 patients with NLPHL.

Figure 3

Figure 3

OS of transformed and nontransformed patients. The median OS in transformed patients was 18.8 years (dotted gray line) vs 19 years in nontransformed patients (black solid line).

Figure 4

Figure 4

Splenic involvement (A) and prior exposure to chemotherapy (B) correlated to freedom from transformation to DLBCL in patients with NLPHL (222 patients). The rates of 40-year freedom from transformation were 87% when there was no splenic involvement (black solid line, A) vs 21% when the spleen was involved (dotted gray line, A) and 87% if radiation therapy was used as a single modality (black solid line, B) compared with 77% in patients treated with prior chemotherapy or chemoradiation combination (dotted gray line, B). Splenic involvement was diagnosed based on pathology or imaging studies.

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