The prognostic impact of variant histology in nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group (GHSG)

Abstract

Key Points• Histopathologic variants of nodular lymphocytepredominant Hodgkin lymphoma are associated with advanced stage and increased relapse rate.• A prognostic score combining histopathologic and clinical features can allocate patients to 3 defined risk groups.Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) accounts for approximately 5% of all Hodgkin lymphoma cases. The aim of this study was to evaluate the prognostic implication of histopathologic NLPHL variants. Biopsies of 423 NLPHL patients treated within 9 prospective clinical trials performed by the German Hodgkin Study Group were classified as tumor cell-rich cases (n 5 10), typical NLPHL (n 5 308), or histopathologic variants (n 5 105). Histopathologic variants were characterized by the presence of lymphoma cells outside the B-cell nodules or B-cell depletion of the microenvironment. Compared with typical NLPHL, histopathologic variants were associated with advanced disease (29.5% vs 14.6%, P 5 .0012) and a higher relapse rate (18.1% vs 6.5% at 5 years, P 5 .0009). Variant histology represented an independent prognostic factor (odds ratio 5 2.955) in a multivariate model of progression/relapse. A prognostic score, including the risk factors variant histopathologic growth pattern, low serum albumin, and male gender, was derived from this model and allowed the definition of 3 distinct risk groups. NLPHL patients presenting with histopathologic variants have a poorer outcome compared with those showing typical histology. The newly developed prognostic score combining histologic and clinical features allows allocating NLPHL patients to defined risk groups. (Blood. 2013;122(26):4246-4252) Continuing Medical Education online This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see page 4292. There is an Inside Blood commentary on this article in this issue.The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked "advertisement" in accordance with 18 USC section 1734. 1 NLPHL more commonly affects males (male-female ratio, 3:1). The median age at...

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

“…The new prognostic score developed by the GHSG, combining clinical and histologic features, especially histopathologic variants to define risk groups, is an interesting approach. 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.…”

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

“…[4][5][6][7] Histopathological variants of NLPHL are associated with increased relapse and advanced stages. 8 Prior observations have reported an increased risk of transformation to aggressive lymphoma, which has been reported to be higher than what is observed in classical HL. 4,[9][10][11][12][13][14][15] Transformation can be seen concurrently or subsequent to the time of NLPHL diagnosis.…”

Staging and Treatment Response Evaluation in Malignant Lymphomas – Czech Lymphoma Study Group Recommendations According to Criteria Revised in 2014 (Lugano Classification)

“…Základem je histologické stanovení subtypu lymfomu s možným zpřesněním pomocí bio logických markerů. V běžné praxi však tyto markery dosud nemodifikovaly klasické klinické prognostické indexy, které jsou stále zá-kladem pro vstupní hodnocení a stratifikaci léčby [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Prognostické faktory jsou specifické pro určité typy lymfomů a většinou zahrnují klinické stadium (KS), věk, tělesnou kondici (performance status -PS) a hodnotu laktátdehydroge-názy (LDH).…”