Objective:

To examine the incidence of histologic transformation (HT) in nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) and evaluate survival outcomes of transformed NLPHL (t-NLPHL) compared to non-transformed NLPHL and de novo diffuse large B-cell lymphoma (DLBCL), highlighting the clinical significance of these comparisons.

Key Findings:

• Cumulative incidence of HT in NLPHL was 2.59% over a median follow-up of 5.58 years, with specific survival rates for non-transformed NLPHL included for context.
• Patients with t-NLPHL had significantly lower survival estimates compared to non-transformed NLPHL, with specific rates provided.
• Survival rates for t-NLPHL were better than for de novo DLBCL, indicating a unique outcome pattern, emphasizing clinical relevance.

Interpretation:

Transformation from NLPHL to DLBCL occurs infrequently but is associated with poorer survival outcomes, with t-NLPHL patients having better survival rates compared to de novo DLBCL patients, underscoring the clinical implications of these findings.

Limitations:

• Study limited to data from SEER-17, which may not capture all cases of NLPHL, potentially affecting generalizability.
• Potential biases in survival estimates due to missing data and the nature of retrospective analysis, which could impact the study's conclusions.

Conclusion:

Transformation in NLPHL is rare but leads to worse outcomes. Despite this, t-NLPHL patients have survival rates comparable to those with de novo DLBCL, suggesting distinct clinical behavior and the need for tailored management strategies.