Follow-Up

Despite a usually favorable prognosis, there is a tendency for histological transformation of NLPHL to diffuse large B-cell lymphoma or T-cell–rich large B-cell lymphoma in approximately 10% of patients by 10 years.[6,22,23] This propensity of NLPHL to transform to aggressive B-cell lymphoma underscores the importance of long-term follow-up and rebiopsy at relapse.[22,24]

With a median follow-up of 7 to 8 years, more patients died of treatment-related toxic effects (acute and long-term) than of recurrent HL. Limitation of radiation dose and fields and avoidance of leukemogenic chemotherapeutic agents, along with watchful waiting policies, should be investigated for these subgroups.[5,17,25]

The treatment approach for relapsing disease is similar to that for recurrent follicular lymphoma. Based on age and performance status, some patients receive sequential therapies and watchful waiting, and some patients receive aggressive salvage chemoimmunotherapy (like R-ICE [rituximab, ifosfamide, carboplatin, and etoposide]) followed by stem cell transplant.[7,26,27]