R-CVP in Nodular Lymphocyte Predominant Hodgkin Lymphoma in Children

Introduction : A strategy of therapeutic de-escalation has been proposed for children with localized stage nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL) over the past twenty years : either local surgical treatment and watch and wait after complete resection of an isolated adenopathy or low intensity chemotherapy ±Rituximab (R). Here, we provide results on the management and efficacy of R-CVP in children with early stage NLPHL.

Methods : A retrospective multicenter national study was carried out in the centers of the French Children's Cancers Society (SFCE) to evaluate the tolerability and efficacy of 3 courses of Rituximab 375 mg/m2-Cyclophosphamide (500 mg/m² day 1), Vinblastine 6 mg/m² day 1 and 8, Prednisolone (40 mg/m² day 1-8) (R-CVP) treatment in NLPHL patients under 18 years of age diagnosed between January 2015 and December 2023. NLPHL diagnosis was confirmed by hematopathologist review and the staging was evaluated by FDG-TEP/CT in all patients.

Results : Twelve children, median age at diagnosis 12 years, (range 7-16 years); boys n=10 received R-CVP between January 2019 and December 2023 in SFCE centers. No patient were treated by R-CVP before 2019 in France. Patients were classified as stage IA n=4 , stage IIA n=7 and stage IIIA n=1. Six patients were treated by R-CVP as first line treatment at initial diagnosis, 3 cases for residual adenopathy post initial surgery, 3 cases after relapse (median time to relapse 9 months) after primary treatment by local surgery and/or radiotherapy. All patients achieved complete remission. In 10/12 cases R-CVP course was performed every 21 days, only one patient received R-CVP every 15 days. Stage IIIA received 4 courses of R-CVP. With a median follow up of 23 months (8-45 months) EFS and OS is 100%. Forty-two percent presented neutropenia at d17 (nadir 0.3 G/l and 0.6 G/l first and third course, respectively). No patient needed blood transfusion support. Grade II mucositis and febrile neutropenia were reported as well as grade I/II peripheral sensitive neuropathy, constipation or digestive disorders

Conclusion: Our results show that R-CVP is an effective chemotherapy regimen in children with localized stage NLPHL. Limited hematological toxicities and peripheral neuropathy were reported during the treatment

Simonin:Clinigen: Honoraria. Landman-Parker:MSD: Consultancy; Novartis, BMS, MSD, Pfizer, Daïchi, Abbvie, Sanofi: Research Funding.