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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)


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


  • Cyclophosphamide
  • Vinblastine
  • Prednisone

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

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as 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 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 Revised: March 29, 2017

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