International Prognostic Score for Nodular Lymphocyte–Predominant Hodgkin Lymphoma

PURPOSE Nodular 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. METHODS Thirty-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. RESULTS We 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). CONCLUSION In 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).

Авторы
Binkley Michael Sargent 1 , Flerlage Jamie E. 2 , Savage Kerry J. 3 , Akhtar Saad 4 , Steiner Raphael 5 , Zhang Xiao-Yin 6 , Dickinson Michael 7 , Prica Anca 8 , Major Ajay 9 , Hendrickson Peter G. 10 , Hopkins David 11 , Ng Andrea 12 , Casulo Carla 13 , Baron Jonathan 14 , Roberts Kenneth B. 15 , Al Kendi Jalila 16 , Balogh Alex 17 , Ricardi Umberto 18 , Torka Pallawi 19 , Specht Lena 20 , De Silva Ravindu 21 , Pickard Keir 22 , Blazin Lindsay J 23 , Henry Michael 24 , Smith Christine M. 25 , Halperin Daniel 26 , Brady Jessica 27 , Brennan Bernadette 28 , Senchenko Maria Anatolevna 29 , Reeves Marie 30 , Hoppe Bradford S. 31, 32 , Terezakis Stephanie 33 , Talaulikar Dipti 35, 34 , Picardi Marco 36 , Kirova Youlia 37 , Fergusson Paige 38 , Hawkes Eliza A. 39, 40 , Lee Denise 41 , Doo Nicole Wong 42, 40 , Barraclough Allison 43 , Cheah Chan Y. 44, 45 , Ku Matthew 46, 47 , Hamad Nada 50, 48, 49 , Mutsando Howard 49, 51 , Gilbertson Michael 52 , Marconi Tamara 53 , Viiala Nicholas 54, 55 , Maurer Matthew J 56 , Eichenauer Dennis A 57 , Hoppe Richard T. 1 , Borchmann Peter , Fuchs Michael , Hartmann Sylvia , Eich Hans Theodor , Lo Andrea C. , Skinnider Brian , Rauf M.Shahzad , Maghfoor Irfan , Pinnix Chelsea C. , Milgrom Sarah A , Vega Francisco , Alomari Mohammed , Collins Graham P. , Advani Ranjana H. , Metzger Monika L. , Wirth Andrew , Tsang Richard , Smith Sonali , Kelsey Christopher R. , Mckay Pamela , Koenig Julie , Constine Louis S. , Sakthivel Ku G. , Plastaras John P. , Gao Sarah , Al Rahbi Nasser , Levis Mario , Sridhar Akshay , Shah Nimish , Osborne Wendy , Chang Isabela , Miall Fiona , Mikhaeel George , Penn Anthony , Volchkov Egor Vasilevich 58, 59 , Della Pepa Roberta , Northend Michael , Opat Stephen , Salvaris Ross , Tedjaseputra Aditya , Palese Monica , Shankar Ananth , Natkunam Yasodha , Kelly Kara M.
Журнал
JOURNAL OF CLINICAL ONCOLOGY
Издательство
Lippincott Williams & Wilkins
Номер выпуска
19
Язык
Английский
Страницы
2271-2280
Статус
Опубликовано
DOI
10.1200/JCO.23.01655
Том
42
Год
2024
Организации
  • 1 Department of Radiation Oncology, Stanford School of Medicine, Stanford University, Stanford, CA
  • 2 Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
  • 3 BC Cancer, Vancouver, Canada
  • 4 King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
  • 5 The University of Texas MD Anderson Cancer Center, Houston, TX
  • 6 Oxford University, Oxford, United Kingdom
  • 7 Peter MacCallum Cancer Centre, Melbourne, Australia
  • 8 Princess Margaret Cancer Centre, Toronto, Canada
  • 9 The University of Chicago, Chicago, IL
  • 10 Duke University, Durham, NC
  • 11 Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
  • 12 Dana-Farber Cancer Institute, Boston, MA
  • 13 University of Rochester, Rochester, NY
  • 14 University of Pennsylvania, Philadelphia, PA
  • 15 Yale University, New Haven, CT
  • 16 The Royal Hospital, Muscat, Oman
  • 17 Tom Baker Cancer Centre, Calgary, Canada
  • 18 Department of Oncology, University of Turin, Turin, Italy
  • 19 Roswell Park Comprehensive Cancer Center, Buffalo, NY
  • 20 Copenhagen University Hospital, Copenhagen, Denmark
  • 21 Norfolk and Norwich University Hospital, Norfolk, United Kingdom
  • 22 Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
  • 23 Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
  • 24 Phoenix Children's Hospital, Phoenix, AZ
  • 25 Vanderbilt University Medical Center, Nashville, TN
  • 26 University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
  • 27 Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • 28 Manchester University NHS Foundation Trust, Manchester, United Kingdom
  • 29 Oncology and Immunology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Moscow, Russian Federation
  • 30 Royal Manchester Children's Hospital, Manchester, United Kingdom
  • 31 University of Florida, Gainesville, FL
  • 32 Mayo Clinic, Jacksonville, FL
  • 33 Johns Hopkins University, Baltimore, MD
  • 34 Canberra Health Services, Canberra, Australia
  • 35 College of Health and Medicine, Australian National University, Canberra, Australia
  • 36 Department of Clinical Medicine and Surgery, AOU Federico II, Naples, Italy
  • 37 Institute Curie, Paris, France
  • 38 Birmingham Children's Hospital, Birmingham, United Kingdom
  • 39 Olivia Newton-John Cancer Research Centre at Austin Health, Melbourne, Australia
  • 40 Lymphoma and Related Diseases Registry, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  • 41 Austin Hospital, Eastern Health, Melbourne, Australia
  • 42 Department of Haematology, Concord Hospital, Concord Clinical School, University of Sydney, Sydney, Australia
  • 43 Department of Haematology, Fiona Stanley Hospital, Perth, Australia
  • 44 Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
  • 45 Medical School, University of Western Australia, Perth, Australia
  • 46 Department of Haematology, St Vincent's Hospital, Melbourne, Australia
  • 47 University of Melbourne, Melbourne, Australia
  • 48 Department of Haematology, St Vincent's Hospital Sydney, Sydney, Australia
  • 49 Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
  • 50 School of Medicine, University of Notre Dame, Sydney, Australia
  • 51 University of Queensland Rural Clinical School, Toowoomba, Australia
  • 52 Monash University, Melbourne, Australia
  • 53 Eastern Health, Melbourne, Australia
  • 54 Department of Haematology, Liverpool Hospital, Liverpool, Australia
  • 55 South West Sydney Clinical School, UNSW Medicine, Liverpool, Australia
  • 56 Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
  • 57 Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, German Hodgkin Study Group, Cologne, Germany
  • 58 Российский университет дружбы народов им. Патриса Лумумбы
  • 59 Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Moscow, Russian Federation.
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