TY - JOUR
T1 - International Prognostic Score for Nodular Lymphocyte-Predominant Hodgkin Lymphoma
AU - GLOW Consortium
AU - Binkley, Michael Sargent
AU - Flerlage, Jamie E.
AU - Savage, Kerry J.
AU - Akhtar, Saad
AU - Steiner, Raphael
AU - Zhang, Xiao Yin
AU - Dickinson, Michael
AU - Prica, Anca
AU - Major, Ajay
AU - Hendrickson, Peter G.
AU - Hopkins, David
AU - Ng, Andrea
AU - Casulo, Carla
AU - Baron, Jonathan
AU - Roberts, Kenneth B.
AU - Al Kendi, Jalila
AU - Balogh, Alex
AU - Ricardi, Umberto
AU - Torka, Pallawi
AU - Specht, Lena
AU - De Silva, Ravindu
AU - Pickard, Keir
AU - Blazin, Lindsay J.
AU - Henry, Michael
AU - Smith, Christine M.
AU - Halperin, Daniel
AU - Brady, Jessica
AU - Brennan, Bernadette
AU - Senchenko, Maria Anatolevna
AU - Reeves, Marie
AU - Hoppe, Bradford S.
AU - Terezakis, Stephanie
AU - Talaulikar, Dipti
AU - Picardi, Marco
AU - Kirova, Youlia
AU - Fergusson, Paige
AU - Hawkes, Eliza A.
AU - Lee, Denise
AU - Doo, Nicole Wong
AU - Barraclough, Allison
AU - Cheah, Chan Y.
AU - Ku, Matthew
AU - Hamad, Nada
AU - Mutsando, Howard
AU - Gilbertson, Michael
AU - Marconi, Tamara
AU - Viiala, Nicholas
AU - Maurer, Matthew J.
AU - Eichenauer, Dennis A.
AU - Kelly, Kara M.
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2024/7/1
Y1 - 2024/7/1
N2 - PURPOSENodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare cancer, and large international cooperative efforts are needed to evaluate the significance of clinical risk factors and immunoarchitectural patterns (IAPs) for all stages of pediatric and adult patients with NLPHL.METHODSThirty-eight institutions participated in the Global nLPHL One Working Group retrospective study of NLPHL cases from 1992 to 2021. We measured progression-free survival (PFS), overall survival (OS), transformation rate, and lymphoma-specific death rate. We performed uni- and multivariable (MVA) Cox regression stratified by management to select factors for the lymphocyte-predominant international prognostic score (LP-IPS) validated by five-fold cross-validation.RESULTSWe identified 2,243 patients with a median age of 37 years (IQR, 23-51). The median follow-up was 6.3 years (IQR, 3.4-10.8). Most had stage I to II (72.9%) and few B symptoms (9.9%) or splenic involvement (5.4%). IAP was scored for 916 (40.8%). Frontline management included chemotherapy alone (32.4%), combined modality therapy (30.5%), radiotherapy alone (24.0%), observation after excision (4.6%), rituximab alone (4.0%), active surveillance (3.4%), and rituximab and radiotherapy (1.1%). The PFS, OS, transformation, and lymphoma-specific death rates at 10 years were 70.8%, 91.6%, 4.8%, and 3.3%, respectively. On MVA, IAPs were not associated with PFS or OS, but IAP E had higher risk of transformation (hazard ratio [HR], 1.81; P <.05). We developed the LP-IPS with 1 point each for age ≥45 years, stage III-IV, hemoglobin <10.5 g/dL, and splenic involvement. Increasing LP-IPS was significantly associated with worse PFS (HR, 1.52) and OS (HR, 2.31) and increased risk of lymphoma-specific death (HR, 2.63) and transformation (HR, 1.41).CONCLUSIONIn this comprehensive study of all ages of patients with NLPHL, we develop the LP-IPS to identify high-risk patients and inform upcoming prospective clinical trials evaluating de-escalation of therapy for patients with low LP-IPS scores (<2).
AB - PURPOSENodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare cancer, and large international cooperative efforts are needed to evaluate the significance of clinical risk factors and immunoarchitectural patterns (IAPs) for all stages of pediatric and adult patients with NLPHL.METHODSThirty-eight institutions participated in the Global nLPHL One Working Group retrospective study of NLPHL cases from 1992 to 2021. We measured progression-free survival (PFS), overall survival (OS), transformation rate, and lymphoma-specific death rate. We performed uni- and multivariable (MVA) Cox regression stratified by management to select factors for the lymphocyte-predominant international prognostic score (LP-IPS) validated by five-fold cross-validation.RESULTSWe identified 2,243 patients with a median age of 37 years (IQR, 23-51). The median follow-up was 6.3 years (IQR, 3.4-10.8). Most had stage I to II (72.9%) and few B symptoms (9.9%) or splenic involvement (5.4%). IAP was scored for 916 (40.8%). Frontline management included chemotherapy alone (32.4%), combined modality therapy (30.5%), radiotherapy alone (24.0%), observation after excision (4.6%), rituximab alone (4.0%), active surveillance (3.4%), and rituximab and radiotherapy (1.1%). The PFS, OS, transformation, and lymphoma-specific death rates at 10 years were 70.8%, 91.6%, 4.8%, and 3.3%, respectively. On MVA, IAPs were not associated with PFS or OS, but IAP E had higher risk of transformation (hazard ratio [HR], 1.81; P <.05). We developed the LP-IPS with 1 point each for age ≥45 years, stage III-IV, hemoglobin <10.5 g/dL, and splenic involvement. Increasing LP-IPS was significantly associated with worse PFS (HR, 1.52) and OS (HR, 2.31) and increased risk of lymphoma-specific death (HR, 2.63) and transformation (HR, 1.41).CONCLUSIONIn this comprehensive study of all ages of patients with NLPHL, we develop the LP-IPS to identify high-risk patients and inform upcoming prospective clinical trials evaluating de-escalation of therapy for patients with low LP-IPS scores (<2).
UR - https://www.scopus.com/pages/publications/85197532193
U2 - 10.1200/JCO.23.01655
DO - 10.1200/JCO.23.01655
M3 - Article
C2 - 38531001
AN - SCOPUS:85197532193
SN - 0732-183X
VL - 42
SP - 2271
EP - 2280
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 19
ER -