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Summary: Management of classical Hodgkin lymphoma in older patients is challenging due to poor tolerance of the chemotherapy regimens used in younger patients. We modified the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone), whereby bleomycin and etoposide were removed and cyclophosphamide dose was reduced, for older patients with co‐morbidities. Here we present data from the first 41 patients treated with 'ACOPP' across 3 centres, demonstrating that it can be delivered, with a favourable toxicity profile (TRM 2%) and promising efficacy (2‐year PFS and OS, 73% (95% CI: 52–94) and 93% (95% CI: 80–100) respectively). [ABSTRACT FROM AUTHOR]

The article offers guidelines for the management and investigation of nodular lymphocyte predominant Hodgkin lymphoma(NLPHL) disease. Topics discussed include transformation of NLPHL into diffuse large B-cell lymphoma (DLBCL), imagine and evaluation related to pretreatment of disease, and management of early stage and advance stage NLPHL with radiotherapy, rituximab monotherapy, and combined modality therapy.

Positron emission tomography-computed tomography (PET-CT) scanning has been shown to be more sensitive than bone marrow biopsy (BMB) in detecting bone marrow involvement (BMI) in classical Hodgkin lymphoma (cHL). In this 5-year retrospective series, 93 (54%) of all new cases of cHL were staged using PET-CT and BMB. PET-CT identified focal bone marrow uptake in 17/93 (18.3%), whilst only five of these (29.4%) were confirmed by BMB. Abnormal pelvic uptake was seen on PET-CT in these five cases. The other 12 cases were missed, giving BMB a sensitivity of 29.4% and a specificity of 100%. PET-CT upstaged 9.7% of patients compared to CT alone. BMB upstaged only one patient; however, this patient was already stage IV on PET-CT. BMB did not alter clinical management in any case. Bone positivity on PET-CT appeared to correlate with anemia, raised lactate dehydrogenase (LDH) and B symptoms. BMB has little or nothing to offer staging cHL in the PET-CT era. [ABSTRACT FROM AUTHOR]

Clinically and biologically, nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) has much more in common with germinal-center derived B-cell non-Hodgkin lymphoma (NHL) than with classical Hodgkin lymphoma (cHL). Management of NLPHL remains controversial. In a 14-year multicenter series, 69 cases were analyzed, and the median follow-up was 53 months (range 11-165.) B-symptoms were present in only 4.3%% of patients, and 81.1%% of patients had stage I/II disease. Treatment was with radiotherapy (53.6%%), chemotherapy (21.7%%), combined modality (17.4%%), and observation (7.2%%). In all, 10.1%% of patients relapsed and 2.9%% of patients developed high-grade transformation to DLBCL. All relapses and transformations were salvageable. No patient died of their disease. The 5-year relapse-free survival was 92%%, transformation-free survival 98.4%%, and overall survival 100%%. We conclude that NLPHL behaves as a distinct clinical entity, often presenting at an early stage without risk factors. It has an excellent outcome. It may be possible, in early-stage disease, to reduce the intensity of therapy in NLPHL, to single-modality radiotherapy, without affecting OS. [ABSTRACT FROM AUTHOR]

GLO:1XW/01may20:bjh16464-fig-0001.jpg PHOTO (COLOR): . gl A 32-year-old male with a history of stage 1A nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) treated four years previously with radiotherapy presented with weight loss. Contrast computed tomography (CT) of neck, thorax, abdomen and pelvis demonstrated widespread small-volume lymphadenopathy and 17-cm splenomegaly. Bone marrow trephine biopsy sections showed a hypercellular marrow with numerous large paratrabecular lymphoid aggregates. [Extracted from the article]

The article discusses the role of positron emission tomography (PET) in the management of Hodgkin lymphoma (HL).