Lymphocyte Predominant Hodgkin Disease

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Lymphocyte-predominant Hodgkin disease (LPHD) is a relatively uncommon his-tologic subtype of HD. LPHD appears to be distinct from classical HD with regard to clinical and biological features. Most patients present with localized disease (stage I or II) without B symptoms. Patients with LPHD generally have an excellent prognosis when treated on protocols for HD that include chemotherapy and/or radiation therapy. However, conventional treatment for HD exposes patients with LPHD to the risk of late effects including second malignant neoplasms as well as cardiac, pulmonary, and endocrine toxicity. There are reports in the literature of patients with LPHD who have been treated with surgery alone; some relapsed and received chemotherapy with or without radiotherapy, while others had no evidence of recurrence with long-term follow-up. The following approach for treatment of LPHD is suggested:

Stage I LPHD may be treated with complete surgical resection alone with long-term observation. At the time of recurrence patients should be treated with four cycles of chemotherapy that contains no alkylating agents as in VAMP (vinblastine, dox-orubicin, methotrexate, prednisone) chemotherapy (Table 15-13) with or without low-dose IFRT (21 Gy). Stage I that is not completely resected and stage II LPHD should be treated with four cycles of chemotherapy as in VAMP with or without low-dose IFRT (21 Gy).

Advanced-stage LPHD patients should be treated like other HD patients with advanced-stage disease.

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