Adult nodular lymphocyte-predominant Hodgkin lymphoma: treatment modality utilization and survival

Cancer Med. 2018 Apr;7(4):1118-1126. doi: 10.1002/cam4.1383. Epub 2018 Feb 26.


Early-stage nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is associated with a favorable prognosis. Our aim was to evaluate the patterns of care of radiotherapy utilization in this disease and to define the relationship between treatment modality and survival. The National Cancer Database was queried for patients with stages I-II NLPHL diagnosed from 2004 to 2012. Patients were compared based on primary therapy into four categories: radiotherapy, chemotherapy, both, or neither. Covariate-adjusted and propensity score-weighted (PS) Cox proportional hazards models were used, adjusting for potential factors confounding survival. After exclusions, 1420 patients were evaluated, 571 (40%) received radiotherapy alone, 318 (22%) received chemotherapy alone, 351 (25%) received both, and 180 (13%) received neither. Younger patient age (P = 0.001), female gender (P = 0.019), and chemotherapy use (P < 0.001) were associated with decreased radiotherapy utilization. On PS, radiation alone (HR = 0.298, P < 0.001) and chemoradiotherapy (HR = 0.258, P < 0.001) were associated with improved survival compared to no upfront therapy, but the use of chemotherapy alone did not statistically differ compared to no initial therapy (HR = 0.784, P = 0.078). In this large database analysis, over one-third of patients with early-stage NLPHL did not receive radiotherapy as a component of initial therapy. The omission of upfront radiotherapy was associated with inferior survival.

Keywords: NLPHL; Chemotherapy; radiation; survival.

MeSH terms

  • Adult
  • Aged
  • Combined Modality Therapy
  • Female
  • Hodgkin Disease / diagnosis*
  • Hodgkin Disease / mortality
  • Hodgkin Disease / therapy
  • Humans
  • Kaplan-Meier Estimate
  • Lymph Nodes / pathology*
  • Lymphocytes / pathology*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Odds Ratio
  • Prognosis
  • Proportional Hazards Models
  • Risk Factors
  • Treatment Outcome