학술논문
International Prognostic Score for Nodular Lymphocyte-Predominant Hodgkin Lymphoma.
Document Type
Academic Journal
Author
Binkley MS; Department of Radiation Oncology, Stanford School of Medicine, Stanford University, Stanford, CA.; Flerlage JE; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.; Savage KJ; BC Cancer, Vancouver, Canada.; Akhtar S; King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.; Steiner R; The University of Texas MD Anderson Cancer Center, Houston, TX.; Zhang XY; Oxford University, Oxford, United Kingdom.; Dickinson M; Peter MacCallum Cancer Centre, Melbourne, Australia.; Prica A; Princess Margaret Cancer Centre, Toronto, Canada.; Major A; The University of Chicago, Chicago, IL.; Hendrickson PG; Duke University, Durham, NC.; Hopkins D; Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.; Ng A; Dana-Farber Cancer Institute, Boston, MA.; Casulo C; University of Rochester, Rochester, NY.; Baron J; University of Pennsylvania, Philadelphia, PA.; Roberts KB; Yale University, New Haven, CT.; Al Kendi J; The Royal Hospital, Muscat, Oman.; Balogh A; Tom Baker Cancer Centre, Calgary, Canada.; Ricardi U; Department of Oncology, University of Turin, Turin, Italy.; Torka P; Roswell Park Comprehensive Cancer Center, Buffalo, NY.; Specht L; Copenhagen University Hospital, Copenhagen, Denmark.; De Silva R; Norfolk and Norwich University Hospital, Norfolk, United Kingdom.; Pickard K; Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom.; Blazin LJ; Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.; Henry M; Phoenix Children's Hospital, Phoenix, AZ.; Smith CM; Vanderbilt University Medical Center, Nashville, TN.; Halperin D; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.; Brady J; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.; Brennan B; Manchester University NHS Foundation Trust, Manchester, United Kingdom.; Senchenko MA; Oncology and Immunology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Moscow, Russian Federation.; Reeves M; Royal Manchester Children's Hospital, Manchester, United Kingdom.; Hoppe BS; University of Florida, Gainesville, FL.; Mayo Clinic, Jacksonville, FL.; Terezakis S; Johns Hopkins University, Baltimore, MD.; Talaulikar D; Canberra Health Services, Canberra, Australia.; College of Health and Medicine, Australian National University, Canberra, Australia.; Picardi M; Department of Clinical Medicine and Surgery, AOU Federico II, Naples, Italy.; Kirova Y; Institute Curie, Paris, France.; Fergusson P; Birmingham Children's Hospital, Birmingham, United Kingdom.; Hawkes EA; Olivia Newton-John Cancer Research Centre at Austin Health, Melbourne, Australia.; Lymphoma and Related Diseases Registry, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Lee D; Austin Hospital, Eastern Health, Melbourne, Australia.; Doo NW; Lymphoma and Related Diseases Registry, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Haematology, Concord Hospital, Concord Clinical School, University of Sydney, Sydney, Australia.; Barraclough A; Department of Haematology, Fiona Stanley Hospital, Perth, Australia.; Cheah CY; Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia.; Medical School, University of Western Australia, Perth, Australia.; Ku M; Department of Haematology, St Vincent's Hospital, Melbourne, Australia.; University of Melbourne, Melbourne, Australia.; Hamad N; Department of Haematology, St Vincent's Hospital Sydney, Sydney, Australia.; Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia.; School of Medicine, University of Notre Dame, Sydney, Australia.; Mutsando H; Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia.; University of Queensland Rural Clinical School, Toowoomba, Australia.; Gilbertson M; Monash University, Melbourne, Australia.; Marconi T; Eastern Health, Melbourne, Australia.; Viiala N; Department of Haematology, Liverpool Hospital, Liverpool, Australia.; South West Sydney Clinical School, UNSW Medicine, Liverpool, Australia.; Maurer MJ; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.; Eichenauer DA; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, German Hodgkin Study Group, Cologne, Germany.; Hoppe RT; Department of Radiation Oncology, Stanford School of Medicine, Stanford University, Stanford, CA.
Source
Publisher: American Society of Clinical Oncology Country of Publication: United States NLM ID: 8309333 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-7755 (Electronic) Linking ISSN: 0732183X NLM ISO Abbreviation: J Clin Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
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).
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).