Resection alone in 58 children with limited stage, lymphocyte‐predominant Hodgkin lymphoma–experience from the European network group on pediatric Hodgkin lymphoma

Abstract

BACKGROUND. Lymphocyte‐predominant Hodgkin lymphoma (LPHL) is a rare, CD20‐positive, good prognostic lymphoma in children. Patients with early‐stage LPHL who underwent successful surgical lymph node resection alone have been reported. To clarify the optimum treatment strategy in children, European study groups were asked to report their experience of surgery alone used in the treatment of pediatric LPHL. METHODS. Data from 58 patients were collected by the French Society for Pediatric Cancers, the German‐Austrian Pediatric Study Group/German Society of Pediatric Oncology and Hematology (Germany), and the Children's Cancer and Leukaemia Group (United Kingdom). In total, there were 50 boys and 8 girls, and the median age was 11 years (age range, 4‐17 years). Fifty‐four patients had stage IA disease, 2 patients had stage IIA disease, and 2 patients had stage IIIA disease. RESULTS. With a median follow‐up of 43 months (range, 2‐202 months), the overall survival rate was 100%, and the progression‐free survival (PFS) rate was 57%. Fifty‐one of 58 patients achieved complete remission (CR) after surgery. In the CR group, the overall PFS rate was 67% (95% confidence interval, 51‐82%). All seven patients who had residual disease after initial surgery developed recurrences (P = .003). Among 18 patients with stage IA LPHL who developed recurrent disease, 11 patients had local recurrences, and 7 patients recurred in stage IIA. One patient with stage IIIA disease presented with high‐grade B‐cell non‐Hodgkin lymphoma at 10 years of follow‐up. CONCLUSIONS. When complete resection was achieved, a substantial proportion of patients with surgically treated, early‐stage LPHL experienced long‐term remission and actually may have been cured. Cancer 2007. © 2007 American Cancer Society.

Nodular lymphocyte predominant Hodgkin lymphoma: a Lymphoma Study Association retrospective study

“…10 Our results show that initiating treatment at the time of diagnosis may improve PFS, compared with watchful waiting, which was the most frequent initial management and concerned more than one-third of our patients. Based on pediatric series, 11,12 the EuroNet-PHL-LP1 study recommends a follow-up without further treatment in children and adolescents with stage IA disease, and complete resection of involved lymph nodes. However, in our study, even after complete surgical resection of local lesions, additional treatment improved PFS compared to watchful waiting.…”

Treating limited-stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome

“…19 Single-agent rituximab has also been explored; but despite a high response rate, it is likewise associated with a high rate of relapse, possibly including transformation to large cell lymphoma. [20][21][22] From these analyses, it appears unlikely that rituximab alone is curative.…”

Nodular lymphocyte predominant Hodgkin lymphoma behaves as a distinct clinical entity with good outcome: evidence from 14-year follow-up in the West of Scotland Cancer Network

“…We note that the numbers managed by observation alone are too small to demonstrate statistical significance, but our outcomes are in agreement with other studies suggesting that management by resection only may be appropriate in selected groups of limited stage patients. 20 The majority of patients were able to be treated by involved-field radiotherapy (IFRT) alone, avoiding many of the toxicities of extended field radiotherapy or chemotherapy. Previous published studies have suggested that for early stage patients, radiotherapy alone may be potentially curative.…”