Treating Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare type of Hodgkin lymphoma (HL) that tends to grow more slowly than classic HL (cHL). It's often treated differently.

For people with early-stage NLPHL without any B symptoms, involved site radiation therapy (ISRT) is often all that's needed. Another option for some people might be to have the lymphoma watched closely at first, and then start treatment when symptoms appear.

If early-stage NLPHL is bulky (large)or is causing B symptoms, the main treatment is usually chemotherapy followed by radiation therapy (ISRT). Many doctors use the ABVD chemo regimen, but some doctors prefer others. The monoclonal antibody rituximab (Rituxan®) might be given along with the chemotherapy. See immunotherapy for Hodgkin lymphoma for more on rituximab.

If the NLPHL is more advanced (stage III or IV), chemotherapy, with or without radiation therapy (ISRT) and/or rituximab, is likely to be recommended. Some patients without B symptoms might be given rituximab alone.

Chemotherapy drugs used for NLPHL

Chemo for NLPHL is not always the same as that used for cHL, though it also combines several drugs because different drugs kill cancer cells in different ways. The combinations used to treat NLPHL are often referred to by abbreviations. Here are the most common combos used in the US. Rituximab can be added to any of them.

ABVD (also used for cHL)

  • Adriamycin® (doxorubicin)
  • Bleomycin
  • Vinblastine
  • Dacarbazine (DTIC)

CHOP

  • Cyclophosphamide (Cytoxan®)
  • Doxorubicin
  • Vincristine (Oncovin®)
  • Prednisone

CVP

  • Cyclophosphamide
  • Vinblastine
  • Prednisone

See Chemotherapy for Hodgkin Lymphoma to learn more. For more general information, see Chemotherapy .

The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Bartlett NL, Foyil KV. Chapter 105: Hodgkin lymphoma. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa. Elsevier: 2014.

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Hodgkin Lymphoma, Version I.2018 -- December 20, 2017. Accessed at www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf on March 19, 2018.

Shanbhag S, Ambinder RF. Hodgkin lymphoma: A review and update on recent progress. CA Cancer J Clin. 2018;68(2):116-132.

Younes A, Carbone A, Johnson P, Dabaja B, Ansell S, Kuruvilla J. Chapter 102: Hodgkin’s lymphoma. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.

Last Medical Review: February 10, 2017 Last Revised: March 29, 2017

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.