CLINICAL PRESENTATION AND OUTCOME IN LYMPHOCYTE-PREDOMINANT HODGKINS-DISEASE

Purpose: The patterns of presentation, histologic pattern (nodular or diffuse), treatment, and long-term outcome were studied in patients wi th lymphocyte-predominant (LP) Hodgkin's disease (HD) to determine whe ther these patients should be treated differently than patients with o ther subtypes of HD. Patients and Methods: pathology was reviewed for 97 patients with an initial diagnosis of LPHD made between 1970 and 19 93. Seventy-five patients had LPHD on review: 55 had nodular LPHD, 14 had diffuse LPHD, and six had LP histology without subclassification. There were 60 males (80%) and 15 females (20%). Sixty-six patients (88 %) presented with clinical stage (CS) I or II disease. Seventy-one pat ients were treated at the Joint Center for Radiation Therapy (JCRT) an d were considered for analysis of treatment outcome. Sixty-one of thes e 71 were treated with radiation (RT) alone; 17 received mantle RT alo ne, 27 mantle and paraaortic RT, and seven total-nodal irradiation (TN I). Ten patients with subdiaphragmatic HD received pelvic and paraaort ic RT. Of the 10 remaining patients, four were treated with RT and che motherapy (CT) and six were treated with CT alone. The median follow-u p rime was 10.8 years. Results: The 10-year actuarial freedom-from-fir st-relapse (FFR) and 10-year overall survival rates for the 71 patient s with LPHD treated at the JCRT were 80% and 93%, respectively. The 10 -year actuarial FFR by nodular (n = 51), diffuse (n = 14), and unspeci fied (n = 6) histologic pattern was 74%, 100%, and 60%, respectively. Overall, 14 of 71 patients have relapsed: nine of 61 with stage IA, IB S, or IIA disease and five of 10 with stage IIB to IVB disease have re lapsed. The median time to relapse was 53 months. Nine of 71 patients have died. Only one death has been from HD: five patients died of seco nd cancers, two of cardiac disease, and one of alcoholic liver cirrhos is. Of seven patients with second malignancies, five died. None of the second malignancies were non-Hodgkin's lymphoma (NHL). Conclusion: Pa tients with LPHD have different patterns of presentation, sex and age distribution, and likelihood of occult abdominal disease than patients with nodular-sclerosing (NS) or mixed-cellularity (MC) disease. The m edian time to relapse for LP patients was later than reported for othe r histologic subtypes; however, there was no pattern of continuous lat e relapse. With pathologic staging and standard treatment, mortality f rom LPHD is low; nearly all deaths have been cardiac or second tumor-r elated. This suggests that less aggressive treatment for LPHD might co ntinue to yield excellent results, while perhaps lowering the long-ter m risk of complications. (C) 1997 by American Society of Clinical Onco logy.