Introduction: Our data demonstrated an unfavorable prognostic value of THRLBCL-like histopathological growth patterns in the tumor substrate. Differentiated approaches of the therapy of this patients group have not been defined yet.
Objective: to evaluate the results of 1st line therapy of advanced stages NLPHL patients with THRLBCL-like histopathological growth patterns in the tumor biopsy, depending on the type of induction chemotherapy program.
Materials and methods: Results of 1st line therapy in 150 patients with NLHLP observed from 2010 to 2021 were analyzed. Growth patterns without THRLBCL-like sites was observed in 87/150 (58%) patients, of them 33 (38%) had advanced stages of the disease (AS). THRLBCL-like patterns were in 63/150 (42%), of them 55 (87%) pts with AS. Patterns with predominance of THRLBCL-like areas (more than 50% of the cut area) - 32 (21%), of them 31 (97%) pts with AS.
Results: In 33/87(38%) pts with growth patterns without THRLBCL-like areas – chemotherapy was performed in 27/33(81%) pts: R-BEACORP-14 in 17/27(63%), R-ABVD in 10/27(37%), all pts achieved complete remission (CR). In of 55/63(87%) pts with advanced stages and with THRLBCL-like patterns, chemotherapy was underwent in 54/55(98%) pts: R-BEACORP-14 - 30/54(56%), of them CR - 18/ 30(60%); R-CHOP - 12/54 (21%), of them CR - 4/12 (30%); other - 12/54 (23%) pts. In 31/32(97%) pts with advanced stages and with predominance of THRLBCL-like areas, chemotherapy received 30/31(97%) pts: R-BEACORP-14 - 17/30(57%), of them CR - 8/17( 47%); R-CHOP - 8/30 (27%), of them CR - 2/8 (25%); other - 5/30 (17%) pts. In pts groups with the presence and predominance of THRLBCL-like growth patterns the 5-year OS on the R-BEACOPP-14 scheme was 100% and 62%, and on the R-CHOP - 100% and 69% (p-0.02), respectively. The 3-year EFS on the R-BEACORP-14 scheme was 91% and 44%, and on the R-CHOP - 50% and 29% (p-<0.0001), respectively. Median follow-up is 34 months.
Conclusion: Induction therapy with R-BEACORP-14 allows to achieved the best overall and event-free survival in an unfavorable group of advanced stages NLPHL patients with the presence and predominance of THRLBCL-like growth patterns.