Historical outcomes for patients with stage IA NLPHL: Global NLPHL One Working Group retrospective analyses

Jamie E. Flerlage; Dennis A. Eichenauer; Michael Fuchs; Sylvia Hartmann; Hans T. Eich; Kerry J. Savage; Andrea C. Lo; Brian Skinnider; Saad Akhtar; M. Shahzad Rauf; Irfan Maghfoor; Chelsea C. Pinnix; Raphael Steiner; Sarah A. Milgrom; Francisco Vega; Mohammed Alomari; Xiao Yin Zhang; Graham P. Collins; Ranjana H. Advani; Priyadarshini Kumar; Michael Dickinson; Andrew Wirth; Richard Tsang; Anca Prica; Ajay Major; Sonali Smith; Peter G. Hendrickson; Christopher R. Kelsey; David Hopkins; Pamela McKay; Andrea Ng; Julie Koenig; Louis S. Constine; Carla Casulo; Gukan Sakthivel; Jonathan Baron; John P. Plastaras; Kenneth B. Roberts; Sarah Gao; Jalila Al Kendi; N. Al Rahbi; Alex Balogh; Mario Levis; Umberto Ricardi; Akshay Sridhar; Pallawi Torka; Lena Specht; Ravindu De Silva; Nimish Shah; Keir Pickard; Wendy Osborne; Lindsay J. Blazin; Michael Henry; Isabela Chang; Christine M. Smith; Daniel Halperin; Fiona Miall; Jessica L. Brady; George Mikhaeel; Bernadette Brennan; Anthony Penn; Marila A. Senchenko; Egor Vasilevich Volchkov; Marie Reeves; Bradford Hoppe; Stephanie Terezakis; Dipti Talaulikar; Roberta Della Pepa; Marco Picardi; Youlia Kirova; Paige Fergusson; Michael Northend; Eliza Hawkes; Denise Lee; Nicole Wong Doo; Allison Barraclough; Stephen Opat; Chan Y. Cheah; Ross Salvaris; Matthew Ku; Nada Hamad; Howard Mutsando; Aditya Tedjaseputra; Michael Gilbertson; Tamara Marconi; Nicholas Viiala; Monica Palese; Ananth Shankar; Matthew J. Maurer; Yasodha Natkunam; Kara M. Kelly; Peter Borchmann; Richard T. Hoppe; Michael Sargent Binkley

doi:10.1182/bloodadvances.2026020012

Historical outcomes for patients with stage IA NLPHL: Global NLPHL One Working Group retrospective analyses

Jamie E. Flerlage
, Dennis A. Eichenauer
, Michael Fuchs
, Sylvia Hartmann
, Hans T. Eich
, Kerry J. Savage
, Andrea C. Lo
, Brian Skinnider
, Saad Akhtar
, M. Shahzad Rauf
, Irfan Maghfoor
, Chelsea C. Pinnix
, Raphael Steiner
, Sarah A. Milgrom
, Francisco Vega
, Mohammed Alomari
, Xiao Yin Zhang
, Graham P. Collins
, Ranjana H. Advani
, Priyadarshini Kumar

Michael Dickinson, Andrew Wirth, Richard Tsang, Anca Prica, Ajay Major, Sonali Smith, Peter G. Hendrickson, Christopher R. Kelsey, David Hopkins, Pamela McKay, Andrea Ng, Julie Koenig, Louis S. Constine, Carla Casulo, Gukan Sakthivel, Jonathan Baron, John P. Plastaras, Kenneth B. Roberts, Sarah Gao, Jalila Al Kendi, N. Al Rahbi, Alex Balogh, Mario Levis, Umberto Ricardi, Akshay Sridhar, Pallawi Torka, Lena Specht, Ravindu De Silva, Nimish Shah, Keir Pickard, Wendy Osborne, Lindsay J. Blazin, Michael Henry, Isabela Chang, Christine M. Smith, Daniel Halperin, Fiona Miall, Jessica L. Brady, George Mikhaeel, Bernadette Brennan, Anthony Penn, Marila A. Senchenko, Egor Vasilevich Volchkov, Marie Reeves, Bradford Hoppe, Stephanie Terezakis, Dipti Talaulikar, Roberta Della Pepa, Marco Picardi, Youlia Kirova, Paige Fergusson, Michael Northend, Eliza Hawkes, Denise Lee, Nicole Wong Doo, Allison Barraclough, Stephen Opat, Chan Y. Cheah, Ross Salvaris, Matthew Ku, Nada Hamad, Howard Mutsando, Aditya Tedjaseputra, Michael Gilbertson, Tamara Marconi, Nicholas Viiala, Monica Palese, Ananth Shankar, Matthew J. Maurer, Yasodha Natkunam, Kara M. Kelly, Peter Borchmann, Richard T. Hoppe, Michael Sargent Binkley

Pediatrics

University of Rochester
University of Cologne
University of Duisburg-Essen
University of Münster
Provincial Health Services Authority
University of British Columbia
King Faisal Specialist Hospital and Research Centre
University of Texas MD Anderson Cancer Center
Memorial Sloan-Kettering Cancer Center
University of Colorado Anschutz Medical Campus
Oxford University Hospitals NHS Foundation Trust
Stanford University
St. Jude Children Research Hospital
Peter Maccallum Cancer Centre
University Health Network
The University of Chicago
Duke University
Beatson Oncology Centre
Dana-Farber Cancer Institute
University of Pennsylvania
Yale University
Royal Hospital Oman
Tom Baker Cancer Centre
University of Turin
Roswell Park Cancer Institute
University of Copenhagen
Norfolk and Norwich University Hospitals NHS Foundation Trust
Newcastle Upon Tyne Hospitals
Indiana University Bloomington
Phoenix Children's Hospital
Vanderbilt University
University Hospitals of Leicester NHS Trust
Guy's and St Thomas' NHS Foundation Trust
Manchester University NHS Foundation Trust
Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology
People's Friendship University of Russia
University of Florida
Mayo Clinic Florida
Johns Hopkins University
Canberra Health Service
Australian National University
Campania Region and Federico II University Hospital Naples (RandD and DISMET)
Institut Curie
Birmingham Women's and Children's NHS Foundation Trust
University College London Hospitals NHS Foundation Trust
Olivia Newton-John Cancer Research Centre at Austin Health
Monash University
Austin Health
The University of Sydney
Fiona Stanley Hospital
Sir Charles Gairdner Hospital
University of Western Australia
St. Vincent's Hospital Melbourne
University of Melbourne
St. Vincent's Hospital Sydney
University of New South Wales
University of Notre Dame Australia
Queensland Health
University of Queensland
Box Hill Hospital
Liverpool Hospital
Mayo Clinic Rochester, MN

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

We evaluated outcomes by management type for patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) in the Global NLPHL One Working Group retrospective database of 2243 patients with stages I to IV disease diagnosed from 1992 to 2021 at 38 international institutions. A total of 779 patients had stage IA disease with median age of 35 years (range, 3-89) and median follow-up of 6.1 years. The 6-year progression-free survival (PFS) and overall survival were 86.3% and 97.7%, respectively. Outcomes were analyzed for the 2 groups: complete resection and unresected disease. Patients with a complete resection and observation alone (n = 99) had a 6-year PFS of 65.5% vs 90.5% for those who received radiotherapy (RT) (n = 53). Patients with unresected disease (n = 627; 80.5%) had a 6-year PFS of 62.0% for rituximab alone (n = 31), 89.6% for RT alone (n = 325), 76.8% for ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) alone (n = 40), and 94.3% for ABVD plus RT (n = 130). A total of 127 patients relapsed (16.3%), of which 25 (19.7%) had transformation. Our analysis suggests the following: (1) RT improves the PFS in patients with completely resected disease; (2) rituximab or ABVD alone does not appear to achieve a durable response; and (3) chemotherapy was not observed to add additional PFS benefit when used in combination with RT. Thus, for stage IA NLPHL, RT alone is likely sufficient for definitive treatment.

Original language	English
Pages (from-to)	5338-5347
Number of pages	10
Journal	Blood Advances
Volume	10
Issue number	15
DOIs	https://doi.org/10.1182/bloodadvances.2026020012
State	Published - Aug 11 2026

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10.1182/bloodadvances.2026020012

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Flerlage, J. E., Eichenauer, D. A., Fuchs, M., Hartmann, S., Eich, H. T., Savage, K. J., Lo, A. C., Skinnider, B., Akhtar, S., Rauf, M. S., Maghfoor, I., Pinnix, C. C., Steiner, R., Milgrom, S. A., Vega, F., Alomari, M., Zhang, X. Y., Collins, G. P., Advani, R. H., ... Binkley, M. S. (2026). Historical outcomes for patients with stage IA NLPHL: Global NLPHL One Working Group retrospective analyses. Blood Advances, 10(15), 5338-5347. https://doi.org/10.1182/bloodadvances.2026020012

@article{6e2beedd59144504a77ab5f71d45f4b8,

title = "Historical outcomes for patients with stage IA NLPHL: Global NLPHL One Working Group retrospective analyses",

abstract = "We evaluated outcomes by management type for patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) in the Global NLPHL One Working Group retrospective database of 2243 patients with stages I to IV disease diagnosed from 1992 to 2021 at 38 international institutions. A total of 779 patients had stage IA disease with median age of 35 years (range, 3-89) and median follow-up of 6.1 years. The 6-year progression-free survival (PFS) and overall survival were 86.3\% and 97.7\%, respectively. Outcomes were analyzed for the 2 groups: complete resection and unresected disease. Patients with a complete resection and observation alone (n = 99) had a 6-year PFS of 65.5\% vs 90.5\% for those who received radiotherapy (RT) (n = 53). Patients with unresected disease (n = 627; 80.5\%) had a 6-year PFS of 62.0\% for rituximab alone (n = 31), 89.6\% for RT alone (n = 325), 76.8\% for ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) alone (n = 40), and 94.3\% for ABVD plus RT (n = 130). A total of 127 patients relapsed (16.3\%), of which 25 (19.7\%) had transformation. Our analysis suggests the following: (1) RT improves the PFS in patients with completely resected disease; (2) rituximab or ABVD alone does not appear to achieve a durable response; and (3) chemotherapy was not observed to add additional PFS benefit when used in combination with RT. Thus, for stage IA NLPHL, RT alone is likely sufficient for definitive treatment.",

author = "Flerlage, \{Jamie E.\} and Eichenauer, \{Dennis A.\} and Michael Fuchs and Sylvia Hartmann and Eich, \{Hans T.\} and Savage, \{Kerry J.\} and Lo, \{Andrea C.\} and Brian Skinnider and Saad Akhtar and Rauf, \{M. Shahzad\} and Irfan Maghfoor and Pinnix, \{Chelsea C.\} and Raphael Steiner and Milgrom, \{Sarah A.\} and Francisco Vega and Mohammed Alomari and Zhang, \{Xiao Yin\} and Collins, \{Graham P.\} and Advani, \{Ranjana H.\} and Priyadarshini Kumar and Michael Dickinson and Andrew Wirth and Richard Tsang and Anca Prica and Ajay Major and Sonali Smith and Hendrickson, \{Peter G.\} and Kelsey, \{Christopher R.\} and David Hopkins and Pamela McKay and Andrea Ng and Julie Koenig and Constine, \{Louis S.\} and Carla Casulo and Gukan Sakthivel and Jonathan Baron and Plastaras, \{John P.\} and Roberts, \{Kenneth B.\} and Sarah Gao and \{Al Kendi\}, Jalila and \{Al Rahbi\}, N. and Alex Balogh and Mario Levis and Umberto Ricardi and Akshay Sridhar and Pallawi Torka and Lena Specht and \{De Silva\}, Ravindu and Nimish Shah and Keir Pickard and Wendy Osborne and Blazin, \{Lindsay J.\} and Michael Henry and Isabela Chang and Smith, \{Christine M.\} and Daniel Halperin and Fiona Miall and Brady, \{Jessica L.\} and George Mikhaeel and Bernadette Brennan and Anthony Penn and Senchenko, \{Marila A.\} and Volchkov, \{Egor Vasilevich\} and Marie Reeves and Bradford Hoppe and Stephanie Terezakis and Dipti Talaulikar and \{Della Pepa\}, Roberta and Marco Picardi and Youlia Kirova and Paige Fergusson and Michael Northend and Eliza Hawkes and Denise Lee and Doo, \{Nicole Wong\} and Allison Barraclough and Stephen Opat and Cheah, \{Chan Y.\} and Ross Salvaris and Matthew Ku and Nada Hamad and Howard Mutsando and Aditya Tedjaseputra and Michael Gilbertson and Tamara Marconi and Nicholas Viiala and Monica Palese and Ananth Shankar and Maurer, \{Matthew J.\} and Yasodha Natkunam and Kelly, \{Kara M.\} and Peter Borchmann and Hoppe, \{Richard T.\} and Binkley, \{Michael Sargent\}",

note = "Publisher Copyright: {\textcopyright} 2026 American Society of Hematology",

year = "2026",

month = aug,

day = "11",

doi = "10.1182/bloodadvances.2026020012",

language = "English",

volume = "10",

pages = "5338--5347",

journal = "Blood Advances",

issn = "2473-9529",

publisher = "American Society of Hematology",

number = "15",

}

Flerlage, JE, Eichenauer, DA, Fuchs, M, Hartmann, S, Eich, HT, Savage, KJ, Lo, AC, Skinnider, B, Akhtar, S, Rauf, MS, Maghfoor, I, Pinnix, CC, Steiner, R, Milgrom, SA, Vega, F, Alomari, M, Zhang, XY, Collins, GP, Advani, RH, Kumar, P, Dickinson, M, Wirth, A, Tsang, R, Prica, A, Major, A, Smith, S, Hendrickson, PG, Kelsey, CR, Hopkins, D, McKay, P, Ng, A, Koenig, J, Constine, LS, Casulo, C, Sakthivel, G, Baron, J, Plastaras, JP, Roberts, KB, Gao, S, Al Kendi, J, Al Rahbi, N, Balogh, A, Levis, M, Ricardi, U, Sridhar, A, Torka, P, Specht, L, De Silva, R, Shah, N, Pickard, K, Osborne, W, Blazin, LJ, Henry, M, Chang, I, Smith, CM, Halperin, D, Miall, F, Brady, JL, Mikhaeel, G, Brennan, B, Penn, A, Senchenko, MA, Volchkov, EV, Reeves, M, Hoppe, B, Terezakis, S, Talaulikar, D, Della Pepa, R, Picardi, M, Kirova, Y, Fergusson, P, Northend, M, Hawkes, E, Lee, D, Doo, NW, Barraclough, A, Opat, S, Cheah, CY, Salvaris, R, Ku, M, Hamad, N, Mutsando, H, Tedjaseputra, A, Gilbertson, M, Marconi, T, Viiala, N, Palese, M, Shankar, A, Maurer, MJ, Natkunam, Y, Kelly, KM, Borchmann, P, Hoppe, RT & Binkley, MS 2026, 'Historical outcomes for patients with stage IA NLPHL: Global NLPHL One Working Group retrospective analyses', Blood Advances, vol. 10, no. 15, pp. 5338-5347. https://doi.org/10.1182/bloodadvances.2026020012

TY - JOUR

T1 - Historical outcomes for patients with stage IA NLPHL

T2 - Global NLPHL One Working Group retrospective analyses

AU - Flerlage, Jamie E.

AU - Eichenauer, Dennis A.

AU - Fuchs, Michael

AU - Hartmann, Sylvia

AU - Eich, Hans T.

AU - Savage, Kerry J.

AU - Lo, Andrea C.

AU - Skinnider, Brian

AU - Akhtar, Saad

AU - Rauf, M. Shahzad

AU - Maghfoor, Irfan

AU - Pinnix, Chelsea C.

AU - Steiner, Raphael

AU - Milgrom, Sarah A.

AU - Vega, Francisco

AU - Alomari, Mohammed

AU - Zhang, Xiao Yin

AU - Collins, Graham P.

AU - Advani, Ranjana H.

AU - Kumar, Priyadarshini

AU - Dickinson, Michael

AU - Wirth, Andrew

AU - Tsang, Richard

AU - Prica, Anca

AU - Major, Ajay

AU - Smith, Sonali

AU - Hendrickson, Peter G.

AU - Kelsey, Christopher R.

AU - Hopkins, David

AU - McKay, Pamela

AU - Ng, Andrea

AU - Koenig, Julie

AU - Constine, Louis S.

AU - Casulo, Carla

AU - Sakthivel, Gukan

AU - Baron, Jonathan

AU - Plastaras, John P.

AU - Roberts, Kenneth B.

AU - Gao, Sarah

AU - Al Kendi, Jalila

AU - Al Rahbi, N.

AU - Balogh, Alex

AU - Levis, Mario

AU - Ricardi, Umberto

AU - Sridhar, Akshay

AU - Torka, Pallawi

AU - Specht, Lena

AU - De Silva, Ravindu

AU - Shah, Nimish

AU - Pickard, Keir

AU - Osborne, Wendy

AU - Blazin, Lindsay J.

AU - Henry, Michael

AU - Chang, Isabela

AU - Smith, Christine M.

AU - Halperin, Daniel

AU - Miall, Fiona

AU - Brady, Jessica L.

AU - Mikhaeel, George

AU - Brennan, Bernadette

AU - Penn, Anthony

AU - Senchenko, Marila A.

AU - Volchkov, Egor Vasilevich

AU - Reeves, Marie

AU - Hoppe, Bradford

AU - Terezakis, Stephanie

AU - Talaulikar, Dipti

AU - Della Pepa, Roberta

AU - Picardi, Marco

AU - Kirova, Youlia

AU - Fergusson, Paige

AU - Northend, Michael

AU - Hawkes, Eliza

AU - Lee, Denise

AU - Doo, Nicole Wong

AU - Barraclough, Allison

AU - Opat, Stephen

AU - Cheah, Chan Y.

AU - Salvaris, Ross

AU - Ku, Matthew

AU - Hamad, Nada

AU - Mutsando, Howard

AU - Tedjaseputra, Aditya

AU - Gilbertson, Michael

AU - Marconi, Tamara

AU - Viiala, Nicholas

AU - Palese, Monica

AU - Shankar, Ananth

AU - Maurer, Matthew J.

AU - Natkunam, Yasodha

AU - Kelly, Kara M.

AU - Borchmann, Peter

AU - Hoppe, Richard T.

AU - Binkley, Michael Sargent

PY - 2026/8/11

Y1 - 2026/8/11

N2 - We evaluated outcomes by management type for patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) in the Global NLPHL One Working Group retrospective database of 2243 patients with stages I to IV disease diagnosed from 1992 to 2021 at 38 international institutions. A total of 779 patients had stage IA disease with median age of 35 years (range, 3-89) and median follow-up of 6.1 years. The 6-year progression-free survival (PFS) and overall survival were 86.3% and 97.7%, respectively. Outcomes were analyzed for the 2 groups: complete resection and unresected disease. Patients with a complete resection and observation alone (n = 99) had a 6-year PFS of 65.5% vs 90.5% for those who received radiotherapy (RT) (n = 53). Patients with unresected disease (n = 627; 80.5%) had a 6-year PFS of 62.0% for rituximab alone (n = 31), 89.6% for RT alone (n = 325), 76.8% for ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) alone (n = 40), and 94.3% for ABVD plus RT (n = 130). A total of 127 patients relapsed (16.3%), of which 25 (19.7%) had transformation. Our analysis suggests the following: (1) RT improves the PFS in patients with completely resected disease; (2) rituximab or ABVD alone does not appear to achieve a durable response; and (3) chemotherapy was not observed to add additional PFS benefit when used in combination with RT. Thus, for stage IA NLPHL, RT alone is likely sufficient for definitive treatment.

AB - We evaluated outcomes by management type for patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) in the Global NLPHL One Working Group retrospective database of 2243 patients with stages I to IV disease diagnosed from 1992 to 2021 at 38 international institutions. A total of 779 patients had stage IA disease with median age of 35 years (range, 3-89) and median follow-up of 6.1 years. The 6-year progression-free survival (PFS) and overall survival were 86.3% and 97.7%, respectively. Outcomes were analyzed for the 2 groups: complete resection and unresected disease. Patients with a complete resection and observation alone (n = 99) had a 6-year PFS of 65.5% vs 90.5% for those who received radiotherapy (RT) (n = 53). Patients with unresected disease (n = 627; 80.5%) had a 6-year PFS of 62.0% for rituximab alone (n = 31), 89.6% for RT alone (n = 325), 76.8% for ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) alone (n = 40), and 94.3% for ABVD plus RT (n = 130). A total of 127 patients relapsed (16.3%), of which 25 (19.7%) had transformation. Our analysis suggests the following: (1) RT improves the PFS in patients with completely resected disease; (2) rituximab or ABVD alone does not appear to achieve a durable response; and (3) chemotherapy was not observed to add additional PFS benefit when used in combination with RT. Thus, for stage IA NLPHL, RT alone is likely sufficient for definitive treatment.

UR - https://www.scopus.com/pages/publications/105045959858

U2 - 10.1182/bloodadvances.2026020012

DO - 10.1182/bloodadvances.2026020012

M3 - Article

C2 - 41979337

AN - SCOPUS:105045959858

SN - 2473-9529

VL - 10

SP - 5338

EP - 5347

JO - Blood Advances

JF - Blood Advances

IS - 15

ER -

Historical outcomes for patients with stage IA NLPHL: Global NLPHL One Working Group retrospective analyses

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