From the Guidelines
The treatment for lymphocyte predominant Hodgkin lymphoma (LPHL) depends on the stage of disease, with early-stage (I-II) LPHL often treated with involved-field radiation therapy (IFRT) at doses of 30-36 Gy, and more advanced disease (stages III-IV) typically treated with combination chemotherapy regimens such as ABVD. For early-stage LPHL, the primary treatment is IFRT at doses of 30-36 Gy, with cure rates exceeding 90% 1. Some key points to consider in the treatment of LPHL include:
- Stage I LPHL patients can be treated with IF radiotherapy (30 Gy) only 1.
- Rituximab is an option for relapsed LPHL, as LPHL cells express CD20 1.
- Autologous stem cell transplantation may be considered for multiple relapses.
- LPHL generally has an excellent prognosis compared to classical Hodgkin lymphoma, with 10-year survival rates over 80%, though it tends to relapse more frequently.
- Treatment decisions should be individualized based on disease extent, patient age, and comorbidities, with long-term follow-up recommended due to the risk of late relapses and potential transformation to aggressive non-Hodgkin lymphoma. The most recent and highest quality study 1 supports the use of IFRT and rituximab in the treatment of LPHL, and highlights the importance of individualized treatment decisions and long-term follow-up.
From the Research
Treatment Options for Lymphocyte Predominant Hodgkin Lymphoma
- The treatment for lymphocyte predominant Hodgkin lymphoma (NLPHL) differs from classical Hodgkin lymphoma in some situations 2.
- Patients with stage IA NLPHL without risk factors have excellent outcomes, with an 8-year progression-free survival (PFS) of roughly 90% and an 8-year overall survival (OS) close to 100% after limited-field radiotherapy (RT) alone 2.
- Individuals presenting with early stages other than stage IA without risk factors and intermediate stages have 10-year PFS rates in excess of 70% and 10-year OS rates exceeding 90% when treated with 2 and 4 cycles of ABVD, respectively, followed by consolidation RT 2.
Advanced-Stage Treatment
- In advanced NLPHL, different protocols such as BEACOPP, ABVD, and R-CHOP have been evaluated retrospectively, but the optimal approach is undefined 2.
- Patients with relapsed NLPHL mostly receive single-agent anti-CD20 antibody treatment or conventional chemotherapy 2.
- High-dose chemotherapy and autologous stem cell transplantation are restricted to high-risk patients 2.
Comparison with Classical Hodgkin Lymphoma Treatment
- The treatment for classical Hodgkin lymphoma often involves chemotherapy regimens such as ABVD, BEACOPP, or Stanford V 3, 4, 5.
- The choice of treatment for classical Hodgkin lymphoma depends on the stage and risk factors of the disease 6, 5.
- In contrast, the treatment for NLPHL is often more tailored to the individual patient's risk factors and stage of disease 2.