From the Guidelines
The treatment for lymphocyte predominant Hodgkin lymphoma (LPHL) typically depends on the stage of disease, with stage I LPHL patients often being treated with involved-field radiation therapy (30 Gy) only, as recommended by the European Society for Medical Oncology 1. For early-stage (stage I or II) LPHL, involved-field radiation therapy alone at doses of 30-36 Gy is often recommended as the primary treatment.
- The treatment approach may vary based on patient factors, including age, comorbidities, and disease characteristics.
- For more advanced disease (stage III or IV), combination chemotherapy regimens are used, with ABVD (Adriamycin/doxorubicin, Bleomycin, Vinblastine, and Dacarbazine) being the most common protocol.
- The ABVD regimen is typically administered every 2 weeks for 2-6 cycles depending on disease extent, followed by radiation in some cases.
- For relapsed or refractory disease, rituximab (375 mg/m² weekly for 4 weeks) may be effective due to the CD20 expression on the malignant cells, as noted in the ESMO clinical recommendations 1. LPHL generally has an excellent prognosis with over 90% long-term survival rates, but requires long-term follow-up due to potential late relapses and the small risk of transformation to aggressive non-Hodgkin lymphoma.
- Treatment decisions should be individualized based on patient factors, including age, comorbidities, and disease characteristics, with the goal of maximizing cure while minimizing long-term treatment toxicities.
From the Research
Treatment Options for Lymphocyte Predominant Hodgkin Lymphoma
- The treatment for lymphocyte predominant Hodgkin lymphoma (NLPHL) depends on the stage and presence of risk factors 2.
- For patients with stage IA NLPHL without risk factors, limited-field radiotherapy alone has shown excellent outcomes, with 8-year progression-free survival (PFS) of roughly 90% and 8-year overall survival (OS) close to 100% 2.
- Individuals with early stages other than stage IA without risk factors and intermediate stages can be treated with 2 and 4 cycles of ABVD, respectively, followed by consolidation radiotherapy, resulting in 10-year PFS rates in excess of 70% and 10-year OS rates exceeding 90% 2.
- In advanced NLPHL, different protocols such as BEACOPP, ABVD, and R-CHOP have been evaluated retrospectively, but the optimal approach is undefined 2.
Role of Radiotherapy in NLPHL Treatment
- Radiotherapy alone can be an effective treatment for early-stage NLPHL, with a study showing 5-year relapse-free and overall survival rates of 95% and 100%, respectively, for patients with stage IA NLPHL treated with involved-field or regional radiotherapy 3.
- The use of radiotherapy as a component of initial therapy has been associated with improved survival compared to no upfront therapy, with a large database analysis showing that omission of upfront radiotherapy was associated with inferior survival 4.
Chemotherapy and Other Treatment Options
- Chemotherapy, such as ABVD, can be used in combination with radiotherapy for the treatment of NLPHL, especially in patients with advanced disease or those who have relapsed 5, 6.
- Newer agents, including brentuximab vedotin and anti-PD-1 antibodies, are being incorporated into frontline therapy for Hodgkin lymphoma, including NLPHL 5, 6.
- High-dose chemotherapy followed by an autologous stem cell transplant is the standard of care for most patients who relapse following initial therapy, while brentuximab vedotin, PD-1 blockade, non-myeloablative allogeneic transplant, or participation in a clinical trial may be considered for patients who fail high-dose chemotherapy with autologous stem cell transplant 5, 6.