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High-dose chemotherapy and autologous stem cell transplantation for relapsed or refractory nodular lymphocyte predominant Hodgkin lymphoma

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Abstract

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a distinct subtype of Hodgkin lymphoma. We report our results of relapsed/refractory NLPHL patients who received high-dose chemotherapy and autogenic stem cell transplantation (HDC auto-SCT). Seventeen NLPHL patients received HDC auto-SCT (1996–2014): male 14 and female 3, with median age at diagnosis of 22 years, at HDC auto-SCT 28 years (15–58 years). At the time of relapse/progression, 13 (76 %) had NLPHL and 4 (24 %) had transformed diffuse large B cell lymphoma. The reason for HDC auto-SCT was refractory NLPHL in 12 patients and relapsed in 5 patients. Salvage chemotherapy was etoposide, methylprednisolone, cisplatinum, and Ara-C (ESHAP); eight patients also received rituximab with ESHAP. HDC was carmustine, etoposide, cytarabine, and melphalan (BEAM). Post-auto-SCT, complete remission was achieved in 14 (82 %), partial remission in 1 (6 %), and progressive disease in 2 (12 %) patients. The median follow-up is 63 months from auto-SCT (6–124 months). Of the nine patients who received only ESHAP, four had post-auto-SCT events versus no event in all eight patients who received rituximab + ESHAP. Kaplan–Meier estimates of 5-year event-free survival for the whole group is 76 %: rituximab + salvage (100 %) versus salvage alone (56 %), P = 0.041. Overall survival is 94 %: 100 versus 89 %, respectively, P = not significant (NS). Even in refractory NLPHL patients, long-term disease-free survival is possible after HDC auto-SCT. Post-auto-SCT relapse or progression can still be managed with chemo/chemo + immunotherapy/radiation. These encouraging results of rituximab in salvage setting should be explored further in a clinical trial setting for this patient population.

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References

  1. Harris NL, Jaffe ES, Stein H et al (1994) A revised European-American classification of lymphoid neoplasms: a proposal from the international lymphoma study group. Blood 84:1361–1392

    PubMed  CAS  Google Scholar 

  2. Illes A, Simon Z, Toth E et al (2008) Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL)-clinicopathological features based on the data of two Hungarian lymphoma centres. Pathol Oncol Res 14:411–421

    Article  PubMed  CAS  Google Scholar 

  3. Fan Z, Natkunam Y, Bair E et al (2003) Characterization of variant patterns of nodular lymphocyte predominant Hodgkin lymphoma with immunohistologic and clinical correlation. Am J Surg Pathol 27:1346–1356

    Article  PubMed  Google Scholar 

  4. Nogova L, Reineke T, Brillant C et al (2008) Lymphocyte-predominant and classical Hodgkin's lymphoma: a comprehensive analysis from the German Hodgkin study group. J Clin Oncol 26:434–439

    Article  PubMed  Google Scholar 

  5. Nogova L, Reineke T, Eich HT et al (2005) Extended field radiotherapy, combined modality treatment or involved field radiotherapy for patients with stage IA lymphocyte-predominant Hodgkin's lymphoma: a retrospective analysis from the German Hodgkin study group (GHSG). Ann Oncol 16:1683–1687

    Article  PubMed  CAS  Google Scholar 

  6. Feugier P, Labouyrie E, Djeridane M et al (2004) Comparison of initial characteristics and long-term outcome of patients with lymphocyte-predominant Hodgkin lymphoma and classical Hodgkin lymphoma at clinical stages IA and IIA prospectively treated by brief anthracycline-based chemotherapies plus extended high-dose irradiation. Blood 104:2675–2681

    Article  PubMed  CAS  Google Scholar 

  7. Hartmann S, Eray M, Doring C et al (2014) Diffuse large B cell lymphoma derived from nodular lymphocyte predominant Hodgkin lymphoma presents with variable histopathology. BMC Cancer 14:332

    Article  PubMed  PubMed Central  Google Scholar 

  8. Huang JZ, Weisenburger DD, Vose JM et al (2003) Diffuse large B-cell lymphoma arising in nodular lymphocyte predominant Hodgkin lymphoma. A report of 21 cases from the Nebraska lymphoma study group. Leuk Lymphoma 44:1903–1910

    Article  PubMed  Google Scholar 

  9. Advani RH, Horning SJ, Hoppe RT et al (2014) Mature results of a phase II study of rituximab therapy for nodular lymphocyte-predominant Hodgkin lymphoma. J Clin Oncol 32:912–918

    Article  PubMed  CAS  Google Scholar 

  10. Eichenauer DA, Fuchs M, Pluetschow A et al (2011) Phase 2 study of rituximab in newly diagnosed stage IA nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin study group. Blood 118:4363–4365

    Article  PubMed  CAS  Google Scholar 

  11. Akhtar S, Al-Sugair AS, Abouzied M et al (2013) Pre-transplant FDG-PET-based survival model in relapsed and refractory Hodgkin's lymphoma: outcome after high-dose chemotherapy and auto-SCT. Bone Marrow Transplant 48:1530–1536

    Article  PubMed  CAS  Google Scholar 

  12. Cheson BD, Pfistner B, Juweid ME et al (2007) Revised response criteria for malignant lymphoma. J Clin Oncol 25:579–586

    Article  PubMed  Google Scholar 

  13. Akhtar S, Weshi AE, Rahal M et al (2008) Factors affecting autologous peripheral blood stem cell collection in patients with relapsed or refractory diffuse large cell lymphoma and Hodgkin lymphoma: a single institution result of 168 patients. Leuk Lymphoma 49:769–778

    Article  PubMed  CAS  Google Scholar 

  14. Jackson C, Sirohi B, Cunningham D et al (2010) Lymphocyte-predominant Hodgkin lymphoma—clinical features and treatment outcomes from a 30-year experience. Ann Oncol 21:2061–2068

    Article  PubMed  CAS  Google Scholar 

  15. Karuturi M, Hosing C, Fanale M et al (2013) High-dose chemotherapy and autologous stem cell transplantation for nodular lymphocyte-predominant Hodgkin lymphoma. Biol Blood Marrow Transplant 19:991–994

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Biasoli I, Stamatoullas A, Meignin V et al (2010) Nodular, lymphocyte-predominant Hodgkin lymphoma: a long-term study and analysis of transformation to diffuse large B-cell lymphoma in a cohort of 164 patients from the adult lymphoma study group. Cancer 116:631–639

    Article  PubMed  Google Scholar 

  17. Bierman P, Naushad H, Loberiza F et al (2006) High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (AHSCT) for lymphocyte predominant Hodgkin’s disease. Blood 108:1a–1062a

    Article  Google Scholar 

  18. Xing KH, Connors JM, Lai A et al (2014) Advanced-stage nodular lymphocyte predominant Hodgkin lymphoma compared with classical Hodgkin lymphoma: a matched pair outcome analysis. Blood 123:3567–3573

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We appreciate Ms. Ruqaya Belkhedim, Mr. Fayez Abu Zeid, and Ms. Reena Ulahannan from BMT clinic, Mr. Edgardo Colcol, Riad Youniss, and Dr. Abida Rehman from Oncology Research Unit, and Ms. Iman Youssef, clinical nurse coordinator, and Haris Syed for reviewing the manuscript for their valuable contribution.

Author contribution

All authors had full access to the manuscript and approved the final version.

Contributions: S.A. was the principal investigator, designed research, collected data, analyzed and interpreted data, and wrote the manuscript. T. Elhassan performed statistical analysis, wrote statistical portion of the manuscript, and provided final approval of the manuscript. S.M.R, M.N.Z, and W.E helped in interpretation of data, drafting the article, and provided final approval of the manuscript. I.M. designed research, collected data, interpreted data, helped in manuscript writing, and provided final approval of the manuscript.

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Author notes

  1. W. Edesa

    Present address: Clinical Oncology Center, Cairo University, Giza, Egypt

Authors and Affiliations

  1. Oncology Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Saudi Arabia

    S. Akhtar, T. A. M. Elhassan, W. Edesa, M. S. Rauf, M. N. Zahir & I. Maghfoor

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  1. S. Akhtar
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  2. T. A. M. Elhassan
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  3. W. Edesa
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Correspondence to S. Akhtar.

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Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Akhtar, S., Elhassan, T.A.M., Edesa, W. et al. High-dose chemotherapy and autologous stem cell transplantation for relapsed or refractory nodular lymphocyte predominant Hodgkin lymphoma. Ann Hematol 95, 49–54 (2016). https://doi.org/10.1007/s00277-015-2527-4

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  • DOI: https://doi.org/10.1007/s00277-015-2527-4

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