Treatment of Nodular Lymphocyte–Predominant HL (NLPHL)

Immunophenotypic differences distinguish NLPHL (CD15-, CD20+, CD30-) from lymphocyte-rich classic Hodgkin lymphoma (HL) (CD15+, CD20-, CD30+).[1,2] The largest retrospective report of 426 cases showed no significant difference in clinical response or outcome to standard therapies for these two subgroups when patients present with early-stage disease (stage I or II).[3][Level of evidence C1]

Patients with NLPHL have earlier-stage disease and longer survival than those with classic HL.[4,5] NLPHL is usually diagnosed in asymptomatic younger patients with cervical or inguinal lymph nodes; this usually occurs without mediastinal involvement. Unlike patients with classic HL, bulky disease, B symptoms, and contiguous spread are uncommon in patients with NLPHL.[6,7] An international prognostic score identified age 45 years or older, stage III or IV disease, hemoglobin less than 10.5 g/dL, and splenic involvement as poor prognostic factors for NLPHL.[8]