Can Rituximab Improve the Outcome of Patients with Nodular Lymphocyte-Predominant Hodgkin's Lymphoma?

Abstract

Background: Nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) is a rare subtype of Hodgkin's lymphoma showing strong CD20 expression. The role of rituximab in treating NLPHL still needs clarification. Methods: We retrospectively reviewed the outcome of 23 patients with NLPHL treated with rituximab alone or in combination with chemotherapy and/or radiotherapy as part of their first- or second-line treatment. Results: The median follow-up of the whole group was 67 months, and all patients remained alive. Twenty-two patients achieved complete remission after rituximab-based therapy, and one of them relapsed 32 months after treatment. One patient treated with rituximab alone achieved partial remission and progressed 22 months after treatment. Conclusion: The prognosis of NLPHL is excellent.Rituximab combined with chemotherapy and/or radiotherapy appears to prevent disease progression/relapse.

Advanced stage nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents: clinical characteristics and treatment outcome – a report from the SFCE & CCLG groups

“…Rituximab combined with CHOP chemotherapy was an effective treatment approach in adult patients with advanced stage nLPHL (Fanale et al , ). A few other studies have similarly shown a clear therapeutic benefit of combining rituximab with chemotherapy in patients with refractory or relapsed nLPHL (Advani et al , ; Lazarovici et al , ; Mocikova et al , ; Shankar et al , ). The relapse rate in the chemotherapy only group in our cohort compared to the rituximab plus chemotherapy group was nearly double (15%; 3/20 vs. 8·3%; 1/12).…”

Role of Rituximab Addition to First-line Chemotherapy Regimens in Nodular Lymphocyte-predominant Hodgkin Lymphoma: A Study by Fondazione Italiana Linfomi

“…However, the advantage offered by the introduction of rituximab in association with chemotherapy is currently still under debate. 8 , 10 , 15 , 24 …”

“…Regarding the role of rituximab combined with chemotherapy, feasibility and efficacy of this approach has been previously described. Fanale et al 13 reported an excellent outcome in 27 patients with NLPHL treated with R-CHOP (5-year PFS 88.5% and 5-year OS of 100%) and Mocikova et al 15 reported a 5-year PFS of 90% and a 5-year OS of 100% in 23 patients treated with immunochemotherapy.…”

“…However, the advantage offered by the introduction of rituximab in association with chemotherapy is currently still under debate. 8,10,15,24 In reference to a cHL oriented strategy, a recent retrospective study published by GHSG showed a good outcome in patients with NLPHL treated as cHL (from HD7 to HD15) with 10-year PFS and 10-year OS of around 75% and 92%. 23 Overall, these data seem to be in line with our results that show a 5-year PFS of around 73% and a 5-year OS of 97% in patients undergoing chemotherapy alone or combined treatment with chemotherapy and RT.…”

What Is the Role of Rituximab in Nodular Lymphocyte-Predominant Hodgkin Lymphoma?

“…No transformation into aggressive lymphoma was observed [7]. In this issue of Acta Haematologica , a retrospective analysis by Mocikova et al [8] reports the outcome of 23 patients with newly diagnosed (n = 13) or relapsed (n = 10) NLPHL who had rituximab-containing therapy. The treatment consisted of single-agent rituximab (n = 12), rituximab plus radiotherapy (n = 2), rituximab plus chemotherapy with CHOP, ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine), BEACOPP (bleomycin, etoposide, Adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone) or DHAP (dexamethasone, high-dose cytarabine, cisplatin; n = 11), and rituximab plus chemotherapy (ABVD or BEACOPP) plus radiotherapy (n = 4), respectively.…”