We evaluated outcomes by management type for patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) in the Global NLPHL One Working Group (GLOW) retrospective database of 2243 patients with stage I-IV disease diagnosed from 1992-2021 at 38 international institutions. 779 patients were stage IA with median age of 35 years (range=3-89) and median follow-up of 6.1 years. The 6-year PFS and OS were 86.3% and 97.7%, respectively. Outcomes were analyzed for two groups: complete resection and unresected disease. Patients with a complete resection and observation alone (n=99) had a 6-year PFS of 65.5% versus 90.5% for those who received RT (n=53). Patients with unresected disease (n=627; 80.5%) had a 6-year PFS of 62.0% for rituximab alone (n=31), 89.6% for RT alone (n=325), 76.8% for ABVD alone (n=40), and 94.3% for ABVD+RT (n=130). 127 patients relapsed (16.3%), of which 25 (19.7%) had transformation. Our analysis suggests 1) RT improves the PFS in patients with completely resected disease; 2) Rituximab or ABVD alone do not appear to achieve a durable response; 3) Chemotherapy was not observed to add additional PFS benefit when used in combination with RT. Thus, for stage IA NLPHL, RT alone is likely sufficient for definitive treatment.
Flerlage et al. (Tue,) studied this question.