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Nodular lymphocyte-predominant Hodgkin lymphoma is the rare, slow-growing cousin of classical Hodgkin lymphoma, so different in its CD20-bearing cells that the WHO renamed it a B-cell lymphoma in 2022. Early disease is usually cured with radiotherapy alone or surgery in children, advanced disease with rituximab-based chemotherapy, and patients are followed for life because it can return late.
Nodular lymphocyte-predominant Hodgkin lymphoma was separated from classical Hodgkin lymphoma in 1994 because its tumour cells, the 'popcorn' or LP cells, are CD20-positive, CD30- and CD15-negative B cells that keep their B-cell programme, sit in nodules of small B lymphocytes and follicular T-helper cells, and lack EBV; the 2022 WHO classification took the logic to its end and renamed the disease nodular lymphocyte-predominant B-cell lymphoma, while the International Consensus Classification kept the older name. It presents with a single group of peripheral nodes (neck, axilla or groin) in a young man, rarely in the mediastinum, and stays indolent for years; but a proportion of cases show T-cell-rich or diffuse growth patterns (Fan patterns C to F) that behave more aggressively and blur into T-cell/histiocyte-rich large B-cell lymphoma, into which the disease transforms in a minority over the following decades.
Treatment is gentler than for classical disease. Stage IA disease without risk factors is cured in most patients by involved-site radiotherapy alone (30 Gy), and children with a completely excised single node can be watched without further treatment, as Children's Oncology Group and EuroNet studies showed. Stage II to IV disease is treated with chemotherapy, usually ABVD or, because the cells are CD20-positive, R-CHOP or R-CVP with rituximab, which some centres prefer for its lower risk of transformation; single-agent rituximab produces responses in most patients but they are not durable. Relapse is common but slow, and relapsed disease is treated with rituximab alone or with chemotherapy, radiotherapy or, rarely, autologous transplantation; transformation is treated as diffuse large B-cell lymphoma. Survival is excellent and most deaths in older series were from treatment or second cancers, which is the reason to treat as little as possible. Because the disease is rare and heterogeneous, trials are small, and the current questions are whether rituximab-based regimens should replace ABVD in advanced disease and how to identify the variant patterns that need more.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma), Mediastinal grey zone lymphoma, Primary effusion lymphoma, Plasmablastic lymphoma, T-cell/histiocyte-rich large B-cell lymphoma, EBV-positive diffuse large B-cell lymphoma, Primary large B-cell lymphoma of the testis, Gastric MALT lymphoma, Ocular adnexal MALT lymphoma, Extranodal NK/T-cell lymphoma, Adult T-cell leukaemia/lymphoma, ALK-positive anaplastic large cell lymphoma, ALK-negative anaplastic large cell lymphoma, Breast implant-associated anaplastic large cell lymphoma, Primary cutaneous anaplastic large cell lymphoma, Lymphomatoid papulosis, Mycosis fungoides, Enteropathy-associated T-cell lymphoma, Monomorphic epitheliotropic intestinal T-cell lymphoma, Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Splenic marginal zone lymphoma, Nodal marginal zone lymphoma, Primary cutaneous marginal zone lymphoma, Primary cutaneous follicle centre lymphoma, Sezary syndrome, Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma), Hepatosplenic T-cell lymphoma, Intravascular large B-cell lymphoma, Lymphomatoid granulomatosis, T-cell prolymphocytic leukaemia, Splenic B-cell lymphoma/leukaemia with prominent nucleoli (formerly B-cell prolymphocytic leukaemia and hairy cell leukaemia variant), T-cell large granular lymphocytic leukaemia, Mixed-phenotype acute leukaemia, Myeloid leukaemia of Down syndrome, Burkitt leukaemia, Marginal zone lymphoma, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Primary mediastinal (thymic) large B-cell lymphoma, Leukaemia (all types), Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Non-Hodgkin lymphoma (all types), Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Polycythaemia vera (PV), Essential thrombocythaemia (ET), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD), FLT3-mutated acute myeloid leukaemia, IDH1- and IDH2-mutated acute myeloid leukaemia, NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia, Secondary and therapy-related acute myeloid leukaemia, Acute promyelocytic leukaemia, Acute myeloid leukaemia in older or unfit patients, Smouldering multiple myeloma, Newly diagnosed multiple myeloma, transplant-eligible, Newly diagnosed multiple myeloma, transplant-ineligible, Relapsed or refractory multiple myeloma, Plasma cell leukaemia, Lower-risk myelodysplastic syndromes, Higher-risk myelodysplastic syndromes, Chronic lymphocytic leukaemia, first treatment, Relapsed or refractory chronic lymphocytic leukaemia, Richter transformation of chronic lymphocytic leukaemia, Chronic myeloid leukaemia, chronic phase, Chronic myeloid leukaemia, accelerated and blast phase, Primary myelofibrosis, Standard-risk B-cell acute lymphoblastic leukaemia in children, High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL), Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year), Relapsed and refractory acute lymphoblastic leukaemia in children, Acute myeloid leukaemia in children, Erdheim-Chester disease, Rosai-Dorfman-Destombes disease, Single-system Langerhans cell histiocytosis (bone, skin or one other organ), Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement), Indolent and smouldering systemic mastocytosis, Advanced systemic mastocytosis (aggressive SM, SM with an associated haematological neoplasm, mast cell leukaemia), Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Relapsed and refractory classical Hodgkin lymphoma
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Excisional node biopsy with expert haematopathology review to distinguish from classical Hodgkin lymphoma and T-cell/histiocyte-rich large B-cell lymphoma; FDG-PET/CT staging.
Involved-site radiotherapy alone (30 Gy); in children, complete excision followed by observation.
ABVD or rituximab-containing chemotherapy (R-CHOP, R-CVP, R-ABVD) with or without involved-site radiotherapy; rituximab alone for frail patients.
Rebiopsy to exclude transformation; rituximab alone or with chemotherapy, radiotherapy for localised relapse; autologous transplantation only for early or repeated relapse.
Treat as diffuse large B-cell lymphoma with R-CHOP.
The malignant cell expresses CD20 and not CD30 or CD15, which is the opposite of classical Hodgkin lymphoma and the reason rituximab works and brentuximab vedotin does not. The WHO fifth edition renames it nodular lymphocyte-predominant B-cell lymphoma, which is a better description. It is indolent, affects men more than women, and relapses late. Stage IA disease without risk factors is treated with involved-site radiotherapy alone, typically 30 Gy, and a substantial proportion never relapse. Complete surgical excision of a single node followed by observation is used in children and in selected adults. More advanced disease is treated with rituximab-containing systemic treatment: R-CHOP, R-ABVD or bendamustine with rituximab, with or without radiotherapy to a residual site. A retrospective population series of 23 patients treated with bendamustine and rituximab in Alberta reported a response rate of 100 per cent, complete response in 78 per cent, and four-year progression-free survival of 83 per cent and overall survival of 87 per cent, which is the kind of evidence this uncommon disease has. The long-term data make the central point about how gently it should be treated. Across 471 patients in the German Hodgkin Study Group HD7 to HD15 trials, ten-year progression-free survival was 75.5 per cent and overall survival 92.1 per cent, but second malignancies occurred in 10.2 per cent, and of 43 deaths only 10 were from the lymphoma against 20 from second cancers and 13 from possibly treatment-related conditions. Over-treatment, not the lymphoma, is the main threat to life here. Transformation to a T-cell/histiocyte-rich large B-cell lymphoma occurs in a minority and is treated as aggressive lymphoma.
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Every lymphoma diagnosis on this site refers to an entity in this classification or the parallel International Consensus Classification.
Nodular lymphocyte-predominant Hodgkin lymphoma is rarely fatal when treated with standard Hodgkin lymphoma protocols, so the goal for most patients is to give less treatment, not more; the minority with advanced or variant disease still need better options.
Query for this cancer: (TITLE:"Nodular lymphocyte-predominant Hodgkin lymphoma" OR ABSTRACT:"Nodular lymphocyte-predominant Hodgkin lymphoma" OR TITLE:"nodular lymphocyte-predominant B-cell lymphoma" OR ABSTRACT:"nodular lymphocyte-predominant B-cell lymphoma" OR TITLE:"NLPHL" OR ABSTRACT:"NLPHL" OR TITLE:"NLPBL" OR ABSTRACT:"NLPBL" OR TITLE:"Nodular lymphocyte-predominant B-cell lymphoma" OR ABSTRACT:"Nodular lymphocyte-predominant B-cell lymphoma" OR TITLE:"Lymphocyte-predominant Hodgkin disease" OR ABSTRACT:"Lymphocyte-predominant Hodgkin disease") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), not a curated reading list.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Breathing very fast, confusion or slurred speech, blue, pale or blotchy skin, a very high or very low temperature, shivering, or a rash that does not fade when pressed: the NHS says call 999 or go to A and E, and do not drive yourself.
Macmillan lists difficulty passing urine, loss of bladder or bowel control and constipation among the signs of spinal cord compression and says to contact the hospital straight away. If you cannot reach anyone, go to A and E and say you have lymphoma and symptoms of spinal cord compression.
Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
Fatal if given intrathecally: label all syringes.
Reduce by 50% for bilirubin 20-50 µmol/L and 75% for 50-85 µmol/L.
See all on the product pages:BendamustineCentral venous access (port, PICC line)CyclophosphamideDoxorubicinFebrile neutropeniaHypogammaglobulinaemia and infection risk after B-cell therapiesMetastatic spinal cord compression (MSCC)NeutropeniaVincristine·Printable cards in the navigator
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