Involved-field radiotherapy alone should be the treatment of choice for stage 1A nodular lymphocyte-predominant Hodgkin lymphoma because it yields similar survival outcomes but fewer toxic effects than other therapies, investigators reported online Aug. 3 in Journal of Clinical Oncology.

Few studies have examined the long-term outcomes of patients who have this generally indolent malignancy, even though late treatment-associated effects are their major cause of death, said Dr. Dennis A. Eichenauer and his associates at University Hospital Cologne and University Hospital Münster, both in Germany.

To assess long-term outcomes in nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), the investigators analyzed data for 256 patients who participated in seven prospective randomized clinical trials comparing various treatments during a 21-year period, who were followed for a median of 91 months. The study participants’ median age at diagnosis was 39 years (range, 16-75 years), and all achieved remission with therapy. They were categorized by treatment type: 108 received involved-field radiotherapy (IF-RT) alone; 49 received extended-field radiotherapy (EF-RT) alone; 72 received combined modality treatment involving various combinations of doxorubicin, bleomycin, vinblastine, dacarbazine, IF-RT, EF-RT, and/or rituximab; and 27 received rituximab alone.

At 8 years, progression-free survival was 91.9% with IF-RT, 84.3% with EF-RT, and 88.5% with combined modalities, which are nonsignificant differences. Overall survival was 99.0%, 95.7%, and 98.6%, respectively, which also are nonsignificant differences. Rituximab alone was markedly less effective than the other treatments, with a 4-year progression-free survival of only 81.0%. “Compared with patients who received IF-RT, patients treated with rituximab had a hazard ratio of 4.99 for relapse,” Dr. Eichenauer and his associates wrote (J Clin Oncol. 2015 Aug 3 [ doi: 10.1200/JCO. 2014.60.4363 ]).

Only 3.7% of patients treated with IF-RT developed a second malignancy during follow-up, compared with 11.1% of those treated with combined modalities, 6.1% of those treated with EF-RT, and 7.4% of those treated with rituximab. The rate of relapse was markedly higher with rituximab than with the other treatments.

The main study findings are twofold. First, IF-RT was at least as effective as other treatments in controlling NLPHL, was less toxic acutely, and carried similar or reduced risks of late adverse effects such as relapse and second malignancies. It should be considered the first-line treatment of choice. Second, rituximab alone should not be used routinely in these patients because it yields poorer survival outcomes and a higher relapse rate. “However, it might represent an option for individual patients, such as young women with abdominal disease, to avoid gonadotoxic effects of radiotherapy,” the investigators said.


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