Top Line: Can PET adaptive therapy be used for nodular lymphocyte predominant Hodgkin lymphoma?
The Study: Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a distinct subtype of HL. However, there is less data to guide the optimal management of NLPHL because it is less common. The NCCN Guidelines prefer radiation and chemoimmunotherapy plus radiation for favorable and unfavorable disease. However, some may extrapolate from classic Hodgkin trials and consider PET adaptive therapy. The German Hodgkin Study Group HD16 and HD17 trials evaluated the PET adaptive use of radiation after initial chemotherapy in patients with favorable and unfavorable early stage HL. One hundred patients in these trials (85% favorable from HD16, 15% unfavorable from HD17) had NLPHL. This study found that their survival outcomes were comparable to those of patients with classic HL on the trials. However, among patients with favorable disease who had a negative PET after initial chemotherapy, the omission of radiation resulted in worse progression free survival at 5 years (83% v 100%). Despite this difference overall survival was 100% at 5 years for all patients with NLPHL.
TBL: This secondary analysis of HD16 and HD17 support the role of radiation therapy in reducing the risk of recurrence for patients with NLPHL regardless of interim PET findings. | Eichenauer, Blood 2023
The Study: Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a distinct subtype of HL. However, there is less data to guide the optimal management of NLPHL because it is less common. The NCCN Guidelines prefer radiation and chemoimmunotherapy plus radiation for favorable and unfavorable disease. However, some may extrapolate from classic Hodgkin trials and consider PET adaptive therapy. The German Hodgkin Study Group HD16 and HD17 trials evaluated the PET adaptive use of radiation after initial chemotherapy in patients with favorable and unfavorable early stage HL. One hundred patients in these trials (85% favorable from HD16, 15% unfavorable from HD17) had NLPHL. This study found that their survival outcomes were comparable to those of patients with classic HL on the trials. However, among patients with favorable disease who had a negative PET after initial chemotherapy, the omission of radiation resulted in worse progression free survival at 5 years (83% v 100%). Despite this difference overall survival was 100% at 5 years for all patients with NLPHL.
TBL: This secondary analysis of HD16 and HD17 support the role of radiation therapy in reducing the risk of recurrence for patients with NLPHL regardless of interim PET findings. | Eichenauer, Blood 2023