NLPHL is a rare form of Hodgkin Lymphoma with different pathological and clinical features from classical Hodgkin Lymphoma. Pathological characteristic of NLPHL is the presence in the tumor of typical CD20 positive lymphocytic and histiocytic (L&H) or “pop corn” cells. Treatment of NLPHL consists of surgical excision alone or external beam radiotherapy for early stage disease, while chemotherapy or combined chemo-radiotherapy are the standard for advanced stages. Recent trials have demonstrated a positive benefit of CD20-targeted immunotherapy with Rituximab in relapsed early stage NLPHLs with impressive overall and complete response rates. We report on the preliminary evaluation of efficacy and outcome of upfront 90Y-Zevalin treatment of patients with NLPHL.
Three patients (2 male, 1 female), age range 46-56 with a recent diagnosis of advanced stage NLPHL were enrolled in a proof of concept study . 111In Zevalin imaging was performed for dosimetry purposes prior to treatment. 90Y-Zevalin treatment was administered in all patients with no prior or concurrent treatment. FDG PET-CT scans were collected at baseline, 8 weeks after treatment and at 6 month intervals following initial response assessment.
All three patients showed advanced stage disease with no B symptoms: 2 had stage III disease and presence of one risk factor (mediastinal or spleen involvement, respectively); the third patient presented as stage II with bulky (> 7 cm) lymphadenopathy. Patients received treatment at the prescribed dose with no significant side effects. At first assessment (8 weeks after treatment) all three patients showed a complete remission (CR). The cumulative follow-up ranged from 52 to 65 months. Two patients relapsed at approximately 11 months from Zevalin treatment and were treated with 8 weekly standard doses of Rituximab, obtaining a second CR lasting 35 and 21 months respectively. Of these patients one has maintained CR status after Rituximab salvage therapy with a cumulative follow-up of 52 months, while the other has maintained a good partial response 65 months following initial Zevalin treatment. The third patient has maintained CR status throughout his 53 month follow-up since radioimmunotherapy.
To our knowledge, the only reports in the literature on the use of radioimmunotherapy in NLPHL are in 6 cases of relapsed disease. We describe the first example of NLPHL patients receiving front line therapy with Zevalin. Our findings suggest that Zevalin treatment may be a safe and effective frontline therapy in advanced stage NLPHL. Clinical trials specifically addressing this setting are warranted.