Management of lymphocyte predominant Hodgkin lymphoma

Abstract

Lymphocyte-predominant Hodgkin lymphoma (LPHL) is a rare disease that is distinct from other types of Hodgkin lymphoma (HL) histologically and clinically. Historically, LPHL was treated similar to classical HL. However, over time, it was recognized that LPHL is highly responsive to treatment (>90% achieve complete response [CR]) and rarely fatal. More LPHL patients die from other causes, including iatrogenic causes such as secondary cancers and fatal coronary heart disease, than from HL. Therefore, gradual attempts have been made to decrease the aggressiveness of LPHL treatment. Currently available evidence suggests that, for patients with early-stage disease, limited-field radiation therapy is effective similar to extended-field radiotherapy with caution regarding differences in median follow-up times between these modalities, and the need for longer follow-up data. For advanced-stage LPHL, patients are commonly treated with chemotherapy with or without radiation therapy. Newer treatment regimens under investigation include the use of rituximab to target the CD20-positive malignant cells, and a watch-and-wait strategy for highly selected pediatric patients who had complete resection of nodal disease. Because of the potential for late recurrences, as well as risk for second cancers, long-term follow-up is necessary. © 2011 Springer-Verlag Berlin Heidelberg.