Minimal Treatment of Low-Risk, Pediatric Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the Children's Oncology Group

Abstract

Some 75% of highly selected pediatric patients with LPHL may be spared chemotherapy after surgical resection alone. Pediatric LPHL has excellent EFS with chemotherapy that is less intensive than standard regimens; > 90% of patients can avoid radiation therapy. The salvage rate for the few relapses is high, with 100% survival overall.

Unfavorable presentation but comparable outcome: Presentation and outcome of children with nodular lymphocyte predominant Hodgkin lymphoma from India

“…In our cohort of 35 patients, 17% patients presented with B symptoms, 31% with central lymphadenopathy, 25% with Stage III/IV disease, 28.5% with extra‐mediastinal bulky disease, and none with mediastinal disease, all of which confirm the lower incidence of high‐risk features in NLPHL compared to classical HL. However, our study had a higher incidence of B symptoms, bulky disease, central lymphadenopathy, and advanced stage disease compared to other studies of pediatric NLPHL . Interestingly, studies describing HL (all subtypes) from India have also shown a higher proportion of advanced stage disease (33–92%) and B symptoms (54%) than Western literature …”

“…In the past 15 years, studies in pediatric NLPHL (including a large recent prospective North American study) have focused on decreasing treatment in early stage NLPHL. Excellent overall survivals have been reported with complete nodal excision of Stage IA (especially when only a single node was involved), involved field radiotherapy alone in Stage IA disease, or lower intensity chemotherapy in early stage unresectable disease . Relapses in NLPHL have been found amenable to salvage chemotherapy, hence the trend toward decreasing the intensity of frontline therapy to minimize the risk of treatment toxicity and late effects .…”

“…Excellent overall survivals have been reported with complete nodal excision of Stage IA (especially when only a single node was involved), involved field radiotherapy alone in Stage IA disease, or lower intensity chemotherapy in early stage unresectable disease . Relapses in NLPHL have been found amenable to salvage chemotherapy, hence the trend toward decreasing the intensity of frontline therapy to minimize the risk of treatment toxicity and late effects . Rituximab has shown potential benefit in frontline as well as salvage treatment in adult NLPHL, however it is yet to be studied in pediatric NLPHL .…”

Outcomes in intermediate‐risk pediatric lymphocyte‐predominant Hodgkin lymphoma: A report from the Children's Oncology Group

“…Given the excellent overall outcomes of patients with LPHL, recent pediatric clinical trials have evaluated regimens with the reduction or elimination of chemotherapy or IFRT, especially in low‐risk patients . Among early‐stage patients with LPHL, COG AHOD03P1 demonstrated that 75% of stage IA patients can avoid chemotherapy after complete surgical resection alone and >90% can avoid IFRT while maintaining excellent outcomes when treated with three cycles of doxorubicin, vincristine, prednisone, and cyclophosphamide (AV‐PC) . The impact of low‐dose IFRT on patients with LPHL was evaluated previously on study CCG‐5942 .…”

“…Typically, LPHL presents with localized peripheral lymphadenopathy with only rare involvement of the mediastinum or extranodal sites . Pediatric patients with early‐stage disease without bulk or B symptoms often have excellent outcomes with surgical resection alone or minimal chemotherapy . However, for pediatric patients with LPHL with unfavorable features such as higher stage disease, B symptoms, or bulk, management is less clear due to their small number in most intermediate‐ or high‐risk HL clinical trials.…”