European Organization for Research and Treatment of Cancer and Groupe d'Etude des Lymphomes de l'Adulte very favorable and favorable, lymphocyte‐predominant Hodgkin disease

• Published in: Cancer Vol. 94; no. 6; pp. 1731 - 1738
• Main Authors: Wilder, Richard B., Schlembach, Pamela J., Jones, Dan, Chronowski, Gregory M., Ha, Chul S., Younes, Anas, Hagemeister, Fredrick B., Barista, Ibrahim, Cabanillas, Fernando, Cox, James D.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 15-03-2002; Wiley-Liss
• Subjects: Adolescent; Adult; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; chemotherapy; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Disease-Free Survival; Female; Hematologic and hematopoietic diseases; Hodgkin Disease - drug therapy; Hodgkin Disease - pathology; Hodgkin Disease - radiotherapy; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; lymphocyte‐predominant Hodgkin disease; Male; Mechlorethamine - administration & dosage; Medical sciences; Middle Aged; Mitoxantrone - administration & dosage; Neoplasm Recurrence, Local; Neoplasm Staging; Pharmacology. Drug treatments; Prednisone - administration & dosage; Procarbazine - administration & dosage; Prognosis; radiotherapy; Retrospective Studies; survival; Treatment Outcome; Vinblastine - administration & dosage; Vincristine - administration & dosage; Antineoplastic agent; Human; Recurrence; Process variant; Hodgkin disease; Early stage; Malignant hemopathy; Radiotherapy; Lymphoma; Survival; Chemotherapy; Treatment; Lymphoproliferative syndrome; Combined treatment; Comparative study
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.10404

BACKGROUND
Lymphocyte‐predominant Hodgkin disease (LPHD) is rare and has a natural history different from that of classic Hodgkin disease. There is little information in the literature regarding the role of chemotherapy in patients with early‐stage LPHD. The objective of this study was to examine recurrence free survival (RFS), overall survival (OS), and patterns of first recurrence in patients with LPHD who were treated with radiotherapy alone or with chemotherapy followed by radiotherapy.
METHODS
From 1963 to 1996, 48 consecutive patients ages 16–49 years (median, 28 years) with Ann Arbor Stage I (n = 30 patients) or Stage II (n = 18 patients), very favorable (VF; n = 5 patients) or favorable (F; n = 43 patients) LPHD, according to the European Organization for Research and Treatment of Cancer and Groupe d'Etude des Lymphomes de l'Adulte (EORTC‐GELA) criteria, received radiotherapy alone (n = 37 patients) or received chemotherapy followed by radiotherapy (n = 11 patients). The percentages of patients with VF disease (11% vs. 9% in the radiotherapy group vs. the chemotherapy plus radiotherapy group, respectively) or F disease (89% vs. 91%, respectively) within the two treatment groups were similar (P = 1.00). A median of three cycles of chemotherapy with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or with mitoxantrone, vincristine, vinblastine, and prednisone (NOVP) was given initially to six patients and five patients, respectively. A median total radiotherapy dose of 40 grays (Gy) given in daily fractions of 2.0 Gy was delivered to both treatment groups.
RESULTS
The median follow‐up was 9.3 years, and 98% of patients were observed for ≥ 3.0 years. RFS was similar for patients who were treated with radiotherapy alone and patients who were treated with chemotherapy followed by radiotherapy (10‐year survival rates: 77% and 68%, respectively; P = 0.89). The OS rate also was similar for the two groups (10‐year survival rates: 90% and 100%, respectively; P = 0.43). MOPP or NOVP chemotherapy did not reduce the risk of recurrence outside of the radiotherapy fields.
CONCLUSIONS
MOPP or NOVP chemotherapy did not improve RFS or OS significantly in patients with VF or F LPHD, although the statistical power was limited. Ongoing clinical trials will help to clarify the role of a watch‐and‐wait strategy or systemic therapy, including anthracycline (epirubicin or doxorubicin), bleomycin, and vinblastine‐based chemotherapy or antibody‐based approaches, in the treatment of these patients. Cancer 2002;94:1731–8. © 2002 American Cancer Society.
DOI 10.1002/cncr.10404
Recurrence free survival for patients with Stage I–II, lymphocyte‐predominant Hodgkin disease categorized as very favorable or favorable, according to the criteria of the European Organization for Research and Treatment of Cancer and the Groupe d'Etude des Lymphomes de l'Adulte, was similar for patients who received radiotherapy alone and patients who received chemotherapy followed by radiotherapy, although the statistical power was limited. Overall survival also was similar for the two treatment groups. Clinical trials are underway to help clarify the role of a watch‐and‐wait strategy or systemic therapy, including anthracycline, bleomycin, and vinblastine‐based chemotherapy or antibody‐based approaches, in patients with favorable, lymphocyte‐predominant Hodgkin disease.