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Clinical Presentation, Course, and Prognostic Factors in Lymphocyte-Predominant Hodgkin's Disease and Lymphocyte-Rich Classical Hodgkin's Disease: Report From the European Task Force on Lymphoma Project on Lymphocyte-Predominant Hodgkin's Disease

From the Department of Internal Medicine, University of Cologne, Germany; and the Pathology Departments of University of Frankfurt, Germany; Massachusetts General Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; University of Groningen, the Netherlands; Christie Hospital, Manchester, United Kingdom; Helsinki University Central Hospital, Helsinki, Finland; Akademisch Ziekenhuis, Leiden, the Netherlands; and Klinikum Benjamin Franklin, Berlin, Germany.

Address reprint requests to Volker Diehl, MD, Klinik I für Innere Medizin, D-50924 Köln, Germany.

PURPOSE: Recent studies have suggested that lymphocyte-predominant Hodgkin's disease (LPHD) is both clinically and pathologically distinct from other forms of Hodgkin's disease, including classical Hodgkin's disease (CHD). However, large-scale clinical studies were lacking. This multicenter, retrospective study investigated the clinical characteristics and course of LPHD patients and lymphocyte-rich classical Hodgkin's disease (LRCHD) patients classified according to morphologic and immunophenotypic criteria.

MATERIALS AND METHODS: Clinical data and biopsy material of all available cases initially submitted as LPHD were collected from 17 European and American centers, stained, and reclassified by expert pathologists.

RESULTS: The 426 assessable cases were reclassified as LPHD (51%), LRCHD (27%), CHD (5%), non–Hodgkin's lymphoma (3%), and reactive lesion (3%); 11% of cases were not assessable. Patients with LPHD and LRCHD were predominantly male, with early-stage disease and few risk factors. Patients with LRCHD were significantly older. Survival and failure-free survival rates with adequate therapy were similar for patients with LPHD and LRCHD, and were stage-dependent and not significantly better than stage-comparable results for CHD (German trial data). Twenty-seven percent of relapsing LPHD patients had multiple relapses, which is significantly more than the 5% of relapsing LRCHD patients who had multiple relapses. Lymphocyte-predominant Hodgkin's disease patients had significantly superior survival after relapse compared with LRCHD or CHD patients; however, this was partly due to the younger average age of LPHD patients.

CONCLUSION: The two subgroups of LPHD and LRCHD bore a close clinical resemblance that was distinct from CHD; the course was similar to that of comparable nodular sclerosis and mixed cellularity patients. Thorough staging is necessary to detect advanced disease in LPHD and LRCHD patients. The question of how to treat such patients, either by reducing treatment intensity or following a "watch and wait" approach, remains unanswered.

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