151 Salvage Autologous Stem Cell Transplantation for Nodular Lymphocyte Predominant Hodgkin Lymphoma: A Single Institution Experience

Track: Contributed Abstracts
Wednesday, February 13, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Saad J Sirop, MD , Hematology, Mayo Clinic, Rochester, MN
Thomas M Habermann, MD , Hematology, Mayo Clinic, Rochester, MN
William R Macon, MD , Pathology, Mayo Clinic, Rochester, MN
Kay M Ritsow , Hematology, Mayo Clinic, Rochester, MN
Stephen M Ansell, MD, PhD , Hematology and Bone Marrow Transplant, Mayo Clinic, Rochester, MN
Joseph P Colgan, MD , Hematology, Mayo Clinic, Rochester, MN
Patrick B Johnston , Hematology and Bone Marrow Transplant, Mayo Clinic, Rochester, MN
Svetomir N Markovic, MD, PhD , Hematology, Mayo Clinic, Rochester, MN
Ivana N Micallef, MD , Hematology and Bone Marrow Transplant, Mayo Clinic, Rochester, MN
Carrie A Thompson, MD , Hematology, Mayo Clinic, Rochester, MN
Luis F Porrata, MD , Hematology and Bone Marrow Transplant, Mayo Clinic, Rochester, MN
James A Martenson, MD , Radiation Oncology, Mayo Clinic, Rochester, MN
Thomas E Witzig, MD , Hematology, Mayo Clinic, Rochester, MN
Grzegorz S Nowakowski, MD , Hematology, Mayo Clinic, Rochester, MN
David J Inwards, MD , Hematology and Bone Marrow Transplant, Mayo Clinic, Rochester, MN
Background:   Nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL) is a more indolent form of Hodgkin Lymphoma that is usually associated with favorable outcomes. There are few reports of refractory disease requiring high dose chemotherapy and autologous stem cell transplantation (ASCT). Long-term follow up and outcomes of refractory NLPHL requiring ASCT are lacking in the literature. The aim of this study was to describe clinical characteristics of relapsed refractory NLPHL and outcomes following ASCT in a cohort of patients followed at a single institution.  

Methods: The actively maintained Mayo Clinic Lymphoma Database includes all consenting consecutive patients with lymphoma seen at Mayo Clinic Rochester. This was used to retrospectively identify patients with NLPHL. The study was approved by the Institutional Review Board. Pathology was confirmed by a hematopathologist. The clinical characteristics, therapy and outcomes of patients with NLPHL were analyzed. 

Results: Between 1970 and 2010, 222 consecutive adult patients with NLPHL were identified. The median follow-up for the entire cohort was 20 years. Forty-six (20.7%) relapsed during the course of the disease and 17 (7.6%) developed a transformation to diffuse large B cell lymphoma. Of the 46 patients, 8 (17.4%) had local relapses and were treated with radiation therapy while 38 (82.6%) were treated with chemotherapy (19 of these 38 patients had no prior exposure to chemotherapy). Nine patients (4% of the entire cohort, 19.6% of relapsed patients) had ASCT. BEAM (BCNU, etoposide, cytarabine and melphalan) conditioning chemotherapy was used in 6 (66.7%) patients. The median age of this group was 29 years (21-52) and the median number of prior regimens was two. All nine patients had prior exposure to ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine) and salvage platinum based therapy was used in three patients (33.3%). The median time from diagnosis to ASCT was 73 months (10-348). Two patients relapsed after ASCT (time to relapse was 4 and 22 months). Seven patients (77.8%) remained disease free after a median follow up of 70 months (32-119). The median overall survival in this group (calculated from diagnosis) was 131 months and the five-year overall survival rate was 55.5%.

Conclusions: In our experience, ASCT was associated with excellent disease control and outcomes in patients with relapsed refractory LPHL.

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