Blood cancers

Rare lymphoma responds to R-CHOP


Patients with advanced nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) can be safely and effectively treated with R-CHOP*, according to a retrospective US study.

Co-author Dr Chan Cheah, now at Sir Charles Gairdner Hospital in WA, told the limbic the rarity of the disease meant prospective studies were difficult.

Yet it was important to try and clarify optimal therapy for the 5% of Hodgkin lymphoma patients with NLPHL.

“Historically, these patients get the same treatment as classical Hodgkin lymphoma yet it is quite a different disease,” Dr Cheah said.

People with NLPHL have higher rates of delayed relapse and higher rates of transformation to more aggressive diffuse large B-cell lymphoma or T-cell rich B-cell lymphoma, he noted.

The review of 59 patients in a single centre between 1995 and 2010 found R-CHOP resulted in ‘excellent response rates and durable remissions’.

Patients treated with R-CHOP with or without radiotherapy had an overall response rate of 100% with complete remission in 89%. Overall response rates were similar with other systemic therapy however there were lower rates of complete remission in patients treated with ABVD (67%) or rituximab (50%) with or without radiotherapy.

No patients treated with R-CHOP experienced histologic transformation during a mean follow-up of 6.7 years however the researchers noted transformation has been reported as late as 20 years after an initial diagnosis.

One patient treated with sub-total node irradiation and one patient treated with R-ABVD experienced transformation at 8.8 and 2.9 years respectively.

“The data shows this is a very chemotherapy sensitive tumour and that a number of regimens will work. However R-CHOP is also better tolerated than ABVD especially in older patients with comorbidities.”

Dr Cheah added that bleomycin was associated with lung toxicities.

The study confirmed male gender (Hazard Ratio 5.08) and splenic involvement (HR 6.94) were adverse prognostic factors for progression free survival with males also having worse overall survival.

‘R-CHOP’  involves the following treatment regimen: rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone.

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