Transformation to Aggressive Lymphoma in Nodular Lymphocyte-Predominant Hodgkin's Lymphoma
Transformation to Aggressive Lymphoma in Nodular Lymphocyte-Predominant Hodgkin's Lymphoma
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DOI：
10.1200/jco.2009.24.9516
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发表时间：
2010-02-10
影响因子：
45.3
通讯作者：
Savage, Kerry J.
中科院分区：
文献类型：
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作者：
Al-Mansour, Mubarak;Connors, Joseph M.;Savage, Kerry J.
目的先前的观察表明，与经典霍奇金淋巴瘤相比，结节性淋巴细胞为主的霍奇金淋巴瘤 (NLPHL) 转化为侵袭性淋巴瘤（最常见的是弥漫性大 B 细胞淋巴瘤 (DLBCL)）的风险更高。我们通过长期随访评估了不列颠哥伦比亚省癌症机构诊断为 NLPHL 的所有患者的转化频率。患者和方法检索了不列颠哥伦比亚省癌症机构的淋巴癌数据库，以识别 1965 年至 2006 年间所有诊断为 NLPHL 的患者。经过病理检查，确诊为 95 例 NLPHL 患者。结果 NLPHL 患者在诊断时具有以下特征：中位年龄 37 岁，73% 为男性， 68% 为 I 期或 II 期疾病。存活患者的中位随访时间为 6.5 年（范围为 2.5 至 33 年），其中 13 名患者 (14%) 转化为侵袭性淋巴瘤（中位转化时间为 8.1 年；范围为 0.35 至 20.3 年）。 10 年和 20 年转化为侵袭性淋巴瘤的精算风险分别为 7% 和 30%。在诊断 NLPHL 时最初有脾脏受累的患者 (P = .006) 发生转化的可能性更大。转化淋巴瘤患者的10年无进展生存率和总生存率分别为52%和62%。结论 NLPHL患者转化为DLBCL的风险很大，但未被充分认识。由于转化可能在 NLPHL 初次诊断后数年发生，因此有必要对这些个体进行长期随访，以准确估计继发性 DLBCL 的发展风险。
PurposePrior observations suggest a higher risk of transformation of nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) to aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL), than in classical Hodgkin's lymphoma. We evaluated the frequency of transformation in all patients diagnosed with NLPHL at the British Columbia Cancer Agency with long-term follow-up.Patients and MethodsThe Lymphoid Cancer Database of the British Columbia Cancer Agency was searched to identify all patients diagnosed with NLPHL between 1965 and 2006. After pathologic review, 95 patients with NLPHL were confirmed.ResultsPatients with NLPHL had the following characteristics at diagnosis: median age of 37 years, 73% male, and 68% stage I or II disease. With a median follow-up time for living patients of 6.5 years (range, 2.5 to 33 years), 13 patients (14%) experienced transformation to aggressive lymphoma (median time to transformation, 8.1 years; range, 0.35 to 20.3 years). The actuarial risk of transformation to aggressive lymphoma was 7% and 30% at 10 and 20 years, respectively. Transformation was more likely in patients with initial splenic involvement (P = .006) at the time of diagnosis of NLPHL. The 10-year progression-free and overall survival rates in patients with transformed lymphoma were 52% and 62%, respectively.ConclusionThe risk of transformation in patients with NLPHL to DLBCL is substantial and underappreciated. Because transformation can occur years after the primary diagnosis of NLPHL, long-term follow-up of these individuals is necessary to accurately estimate the risk of development of secondary DLBCL.