Researchers at the University Hospital Cologne and the University Hospital Münster in Germany recently reported that involved-field radiotherapy is the best treatment option for patients with a type of low-risk Hodgkin’s lymphoma. The study was published in the Journal of Clinical Oncology and is entitled “Long-Term Course of Patients With Stage IA Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the German Hodgkin Study Group”.
Lymphoma refers to a cancer that affects immune cells called lymphocytes, a type of white blood cell that defends the body from infections. Patients with lymphoma may experience swelling of the lymph nodes, fever, night sweats, itching, loss of appetite, sudden weight loss and fatigue. There are two main types of lymphoma: non-Hodgkin’s (about 90% of the cases) and Hodgkin’s (about 10%). Patients with lymphoma may experience swelling of the lymph nodes, fever, night sweats, itching, loss of appetite, sudden weight loss and fatigue.
Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL) is a rare cancer with only around 500 new cases diagnosed per year in the United States. NLPHL is characterized by an overall more indolent disease course with a higher likelihood of delayed relapses.
“Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL) is a rare entity, accounting for approximately 5% of all Hodgkin’s lymphomas,” wrote the research team according to a news release. “Given a mostly indolent clinical course, limited-stage NLPHL is often treated with less aggressive approaches than classical Hodgkin’s lymphoma. … However, this recommendation is based on data from registries as well as retrospective analyses from single institutions and clinical studies with a rather short follow-up.”
In the study, researchers analyzed the standard of care for patients with early-stage NLPHL. In total, 256 patients with NLPHL (median age at diagnosis of 39 years), enrolled in the German Hodgkin Study Group clinical trial protocols between 1988 and 2009, were assessed. The treatments evaluated included involved-field radiotherapy (IF-RT; 108 patients), combined-modality treatment (CMT; 72 patients), extended-field radiotherapy (EF-RT; 49 patients) and four weekly standard doses of rituximab (a standard first-line treatment option, 27 patients).The median follow-up period of the cohort was of 91 months.
Researchers found that in terms of tumor control, CMT, ER-RT and IF-RT had a similar effect. Regarding 8-year progression-free survival rates, this was found to be higher in the group treated with IF-RT (91.9%), followed by patients treated with CMT (88.5%) and with EF-RT (84.3%). These results were also reflected in the 8-year overall survival rates: 99% for patients treated with IF-RT, 98.6% for those under CMT, and 95.7% for those treated with EF-RT.
Rituximab (Rituxan; Genentech, Biogen Idec) monotherapy resulted in a 4-year overall survival rate of 100%, although patients had a median 4-year progression-free survival of 81%, indicating a significantly increased relapse risk in this patient population in comparison to other treatment modalities.
A second malignancy during the follow-up period was diagnosed in 6.6% (17) of the patients. Twelve deaths were reported but only one was due to NLPHL.
The research team concluded that IF-RT is, among the current treatment modalities, is the most appropriate as a standard of care for patients with stage IA NLPHL, while Rituximab monotherapy is not advised due to its association with an increased risk of relapse.
“IF-RT at 30 Gy [Gray; radiation dose] should be the preferred treatment for patients with stage 1A NLPHL presenting without clinical risk factors,” concluded the research team. “This is based on the similar efficacy of IF-RT compared with CMT and EF-RT, the reduced acute toxicity, and the potentially reduced risk for the development of late effects such as second malignancies.” Furthermore, the authors advise “Rituximab alone should not be routinely used in patients with stage 1A NLPHL because of the increased frequency of relapses occurred,”
“The question of whether treatment intensity can be further reduced in low-risk patients with stage 1A NLPHL, while patients who are at higher risk for relapse receive more intensive approaches such as a combination of chemotherapy and an anti-CD20 antibody, should be subject to further studies.” researchers concluded.