Fibrosis in Nodular Sclerosis Hodgkin Lymphoma Is Predictive of a Residual Mass Following Therapy
AJ Church, N Shabazi, DP LeBrun, T Baetz. Queen's University, Kingston, Canada
Background: Persistence of a mass after first-line treatment is a common problem in nodular sclerosis Hodgkin lymphoma (NSHL). Up to 64% of patients demonstrate residual abnormalities on computed tomography (CT), but only 42% of those patients will relapse. Clinicians are faced with the dilemma of whether to pursue second-line treatment for a mass that may be simply scar tissue. The ability to predict which patients are at higher risk for residual mass following curative treatment can aid in the planning of clinical follow-up.
Design: This study was designed to test the hypothesis that the presence of abundant fibrosis in the initial biopsy predicts the presence of residual, post-therapy masses composed primarily of fibrotic tissue. Subjects were consecutive NSHL patients from 1996 to 2007 identified based on the availability of diagnostic histology slides, clinical follow-up data, and the results of post-treatment imaging. Biopsies were reviewed by a lymphoma pathologist and resident without knowledge of the residual mass status. The proportion of the tissue consisting of fibrous material was graded as a percentage of the total biopsy. Clinical charts were reviewed for baseline patient characteristics, cancer stage and presence of a residual mass 6 months after treatment.
Results: Of the 50 subjects included in the study, 27 had a residual mass and 23 did not. Patients with increased fibrosis on initial biopsy were significantly more likely to have a residual mass after therapy (p=0.028). The degree of fibrosis was independent of gender, stage, and Hasenclever score and was the only factor that was predictive of the presence of a residual mass. In fact, for every 10 percentage point increase in the degree of fibrosis, the patient was 1.4 times more likely to have a residual mass. Degree of fibrosis was also predictive of a mass which would be metabolically inactive by Gallium scintigraphy, suggesting benignity.
Conclusions: Taken together, these results suggest that patients with increased fibrosis on their initial NSHL biopsy are more likely to have residual masses, but that these masses are less likely to be malignant. These findings have potential implications for patient follow-up: clinicians may be reassured that a post-treatment mass is less likely to represent persistent malignancy and can be followed with imaging rather than pursuing unnecessary biopsies. Our results further reinforce the importance of functional imaging, particularly in this patient population.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 208, Wednesday Morning