Activity of Rituximab-Bendamustine (RB) Combination in Nodular Lymphocyte Predominant Hodgkins Lymphoma (NLPHL)

Abstract 4894

Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL) is an uncommon subtype of Hodgkin's lymphoma. NLPHL represents a more indolent disease than classical Hodgkin's lymphoma. It has unique clinicopathological features that resemble indolent Non Hodgkin's Lymphomas and hence, the tendency to manage it as such.

We reviewed the activity of Rituximab-Bendamustine (RB) combination in 2 cases of relapsed NLPHL. The first patient is a 53 year old African American man who was diagnosed with Ann-Arbor Stage IIA NLPHL in 2005. He was initially treated with 3 cycles of ABVD after which he was lost to follow up. He sought medical attention in 2008 and a repeat PET/CT showed persistent cervical lymphadenopathy consistent with his known disease but the patient refused therapy at that time. Three years later, he presented with weight loss and enlarging cervical lymph nodes. A repeat biopsy of these nodes confirmed his initial diagnosis of NLPHL. He was reluctant to undergo any chemotherapy similar to the initial treatment because of the side effects. He was then treated with 4 cycles of RB followed by involved field radiation therapy, which he tolerated well. Post therapy PET/CT scan revealed a complete remission. The second patient is a 62 year old white man who was initially diagnosed with IE DLBCL of the proximal jejunum in 2004 which was successfully treated with R-CHOP. After five years he was found to have diffuse lymphadenopathy. Excisional biopsy revealed NLPHL. The patient refused to take adriamycin containing regimen or combination therapy since he poorly tolerated it before and agreed to try RB instead. He was treated with 6 cycles of RB. Re-staging PET/CT scans revealed near complete resolution. The patient was referred for autologous stem cell consolidation. He underwent adequate stem cell collection and successfully engrafted. Both patients continue to be disease free as of their last clinic visit.

Rituximab –Bendamustine combination seems to have significant activity in NLPHL, reminiscent of its activity in indolent non-Hodgkin's lymphomas. Incorporation of the regimen into front line treatment of patients with this disease needs further study and evaluation.