Clinical significance of the severity of THRLBCL-like areas in nodular lymphocyte predominant Hodgkin lymphoma
According to the WHO 2017 the presence of sites resembling T cell/histiocyte-rich large B-cell lymphoma (THRLBCL) in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) does not refer to transformation into THRLBCL.
To compare the severity of THRLBCL-like areas in NLPHL with the clinical course of the disease.
Materials and methods:
The study group included 59 patients with verified diagnosis (morphology, IHC) of NLPHL (2010-2017, NRCH for hematology): m/f ratio 3.4: 1, median age - 35 (range 17-68), with biopsy material of lymph node/other localization of the primary biopsy in the debut of the disease. The severity of THRLBCL-like areas was analyzed using IHC with CD20 antibodies and empirically selected cut off of these sites in 50%, compared with clinical and instrumental data.
Patients with non-classical subvariants (non-A/B, n=42) were divided into 3 subgroups: 1 subgroup 0% (17/42), 2 subgroup - 0>%<50% (11/42), 3 subgroup ≥50% (14/42) THRLBCL-like areas of the area of the lymph node section. In the three analyzed subgroups, there were a significant difference in the frequency of diagnosis of stage IV of the disease (p=0.0507), bone marrow damage (p=0.0005) and spleen (p=0.0101), response to first-line therapy (p=0.0126). Table 1. In the subgroup with the presence of THRLBCL-like areas ≥50%, up to 6 affected extranodal localizations were observed: bone marrow trephine biopsies, spleen, liver, paravertebral soft tissues, bones, thyroid gland.
A subgroup of patients with the presence of THRLBCL-like areas ≥50% of the area of the lymph node section is characterized by the most unfavorable clinical course of the disease.