Contributions
Abstract: PB2020
Type: Publication Only
Background
Predominant lymphocytic nodular Hodgkin's lymphoma (NLPHL) is a rare lymphoma.
Aims
Life expectancy being more than 10 years, short term and long term life-threatening toxicities should be avoided. However, there are no evidence-based guidelines for initial treatment or relapse.
Methods
Two patients relapsing 12 and 17 months after initial treatment with rituximab were included in a prospective phase II trial of radioimmunotherapy (RIT). Yttrium 90 was coupled to rituximab (90Y-rituximab) and administered according to the following protocol : a first infusion of rituximab 250mg/m2, repeated one week later and directly followed by the injection of 90Y-rituximab (14,8 MBq/kg). The rational of using unlabeled (“cold”) antibodies before injecting 90Y-rituximab is to reduce tissue toxicity of RIT by providing a more favorable biodistribution profile of the radiolabeled antibody (Vaes M. et al. J Cancer Sci Ther 2012).
Results
Case # 1:
A 27 years old Mediterranean man noticed in April 2008 a bulky right axillary mass, CS IA.A biopsy was performed and the diagnosis of NLPHL, CD20+ was established. The first line treatment consisted in radiation therapy (RT) and 4 weekly administrations of Rituximab. The 18FDG-PET/CT performed 6 months after the treatment showed a complete metabolic response but after 18 months a moderate hypermetabolic activity in infracarinal lymphadenopathies and beside the spleen is described.
In June 2010, the relapse is confirmed showing lymph node involvement in the right pelvic region, the splenic hilus and the left axillar region. The patient accepted to be enrolled in a RIT protocol in October 2010. This treatment induced a complete remission which is still ongoing after 7 years. No adverse events were reported.
Case #2:
A 38-year-old Caucasian man presented with small bilateral cervical and supraclavicular lymphadenopathies. A biopsy was performed and showed a NLPHL (CD30 +, CD20 +) stage IIIA. 18FDG-PET/CT confirmed cervical but also juxta-centimetric retroperitoneal lymph nodes and rituximab treatment (4 weekly courses) was started in August 2007. Response assessment by18FDG-PET/CT, performed 4 months after the end of the treatment, showed a complete metabolic response. Eleven months after the end of treatment, 18FDG-PET/CT revealed a 2cm diameter retroperitoneal lymph node which increased to 5 cm in diameter at 21 months concomitantly with hypermetabolic retroperitoneal lymph nodes. RIT was started in September 2009, according to our study protocol. No side effects were reported during and after treatment. Six months after RIT, 18FDG-PET/CT showed a complete metabolic remission, persisting until today, 8 years later.
Conclusion
There are no prospective randomized studies to guide the therapy in NLPHL. Radiotherapy plays an essential role in early stages and chemotherapy combined with anti-CD20 antibody is very effective in advanced diseases. We opted for salvage treatment with RIT to treat two young patients with early relapsed NLPHL. A complete response was maintained for 7+ years compared to less than 2 years after rituximab alone. To our knowledge, RIT has never been reported for this indication.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Hodgkin's Lymphoma, Radioimmunotherapy, Rituximab, Salvage therapy
Abstract: PB2020
Type: Publication Only
Background
Predominant lymphocytic nodular Hodgkin's lymphoma (NLPHL) is a rare lymphoma.
Aims
Life expectancy being more than 10 years, short term and long term life-threatening toxicities should be avoided. However, there are no evidence-based guidelines for initial treatment or relapse.
Methods
Two patients relapsing 12 and 17 months after initial treatment with rituximab were included in a prospective phase II trial of radioimmunotherapy (RIT). Yttrium 90 was coupled to rituximab (90Y-rituximab) and administered according to the following protocol : a first infusion of rituximab 250mg/m2, repeated one week later and directly followed by the injection of 90Y-rituximab (14,8 MBq/kg). The rational of using unlabeled (“cold”) antibodies before injecting 90Y-rituximab is to reduce tissue toxicity of RIT by providing a more favorable biodistribution profile of the radiolabeled antibody (Vaes M. et al. J Cancer Sci Ther 2012).
Results
Case # 1:
A 27 years old Mediterranean man noticed in April 2008 a bulky right axillary mass, CS IA.A biopsy was performed and the diagnosis of NLPHL, CD20+ was established. The first line treatment consisted in radiation therapy (RT) and 4 weekly administrations of Rituximab. The 18FDG-PET/CT performed 6 months after the treatment showed a complete metabolic response but after 18 months a moderate hypermetabolic activity in infracarinal lymphadenopathies and beside the spleen is described.
In June 2010, the relapse is confirmed showing lymph node involvement in the right pelvic region, the splenic hilus and the left axillar region. The patient accepted to be enrolled in a RIT protocol in October 2010. This treatment induced a complete remission which is still ongoing after 7 years. No adverse events were reported.
Case #2:
A 38-year-old Caucasian man presented with small bilateral cervical and supraclavicular lymphadenopathies. A biopsy was performed and showed a NLPHL (CD30 +, CD20 +) stage IIIA. 18FDG-PET/CT confirmed cervical but also juxta-centimetric retroperitoneal lymph nodes and rituximab treatment (4 weekly courses) was started in August 2007. Response assessment by18FDG-PET/CT, performed 4 months after the end of the treatment, showed a complete metabolic response. Eleven months after the end of treatment, 18FDG-PET/CT revealed a 2cm diameter retroperitoneal lymph node which increased to 5 cm in diameter at 21 months concomitantly with hypermetabolic retroperitoneal lymph nodes. RIT was started in September 2009, according to our study protocol. No side effects were reported during and after treatment. Six months after RIT, 18FDG-PET/CT showed a complete metabolic remission, persisting until today, 8 years later.
Conclusion
There are no prospective randomized studies to guide the therapy in NLPHL. Radiotherapy plays an essential role in early stages and chemotherapy combined with anti-CD20 antibody is very effective in advanced diseases. We opted for salvage treatment with RIT to treat two young patients with early relapsed NLPHL. A complete response was maintained for 7+ years compared to less than 2 years after rituximab alone. To our knowledge, RIT has never been reported for this indication.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Hodgkin's Lymphoma, Radioimmunotherapy, Rituximab, Salvage therapy