Hodgkin's disease with lymphocyte predominance: Long-term results based oncurrent histopathologic criteria

Purpose: To define the disease course, therapeutic strategies, patterns and rates of relapse and causes of death for patients with Hodgkin's disease w ith lymphocyte predominance (LPHD) and to assess prognostic factors includi ng nodular and diffuse histologic patterns. Patients and Methods: The records of all previously untreated patients with LPHD who received initial treatment at the University of Texas M. D. Ander son Cancer Center (UTMDACC) from 1960 through 1992 were reviewed. Clinical and histopathologic characteristics, specifically nodular and diffuse LPHD, and treatment groups were assessed by overall and relapse-free survival, p atterns of relapse, and causes of death. Results: Of 70 patients, 58 (83%) had nodular LPHD and 12 (17%) had a diffu se pattern: clinical characteristics were similar between the two subtypes. The median age of all patients was 25 years, 79% were male, 96% presented with stage I or II disease and 93% were free of B symptoms. Laparotomy (23 patients) failed to upstage any patient with a negative lymphogram. With a median follow-up of 12.3 years for alive patients, 19 (27%) patients have r elapsed. All 3 relapses among the patients with diffuse subtype occurred wi thin 3 years while 9 of 16 relapses occurred after 5 years with nodular sub type. However, we did not detect any statistically significant difference i n relapse free survival or survival between the subtypes in our patient pop ulation. There was some suggestion that patients aged 40 and older experien ced shorter survival; no other pretreatment characteristics were noted to b e associated with relapse free survival or survival. Though there were no r elapses within the radiation fields, no effect of extent of radiation thera py on relapse rate was observed. Thirteen (19%) patients have died, 6 (8.6% ) of whom succumbed to LPHD. Two patients developed diffuse large cell lymp homa. Conclusions: Patients with LPHD usually present with localized and asymptom atic disease. Laparotomy is unnecessary if the lymphogram is negative. Nodu lar histology occurred in the majority of patients. Though all relapses fro m diffuse subtype occurred within 3 years in contrast to some late relapses observed for nodular subtype, there was no statistically significant diffe rence in relapse free survival or survival between the subtypes. The extent of irradiation had no effect on relapse free survival or survival. We coul d not find any evidence that LPHD should be treated any different from the classical Hodgkin's disease at this point despite suggestions that it be cl assified as a non-Hodgkin's B-cell lymphoma. (C) 1999 Elsevier Science Inc.