# Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)

Source: https://onco.cc/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/  
OnCo record `nodular-lymphocyte-predominant-hodgkin-lymphoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Cancer
- Last checked: 2026-09-18
- Also known as: NLPHL; NLPBL; Nodular lymphocyte-predominant B-cell lymphoma; Lymphocyte-predominant Hodgkin disease; Popcorn cell lymphoma
- Tags: subtype-page; haematologic
- Group: haematologic
- Burden: About one in twenty Hodgkin lymphomas, mostly in men in their thirties and forties and in boys; it is indolent, rarely fatal, but relapses over decades and can transform into an aggressive B-cell lymphoma.
- Subtypes: Stage IA nodular lymphocyte-predominant Hodgkin lymphoma (radiotherapy alone or excision and observation in children); Stage II to IV nodular lymphocyte-predominant Hodgkin lymphoma (ABVD or R-CHOP); Typical nodular growth pattern (Fan patterns A and B; indolent); Variant growth patterns (Fan patterns C to F; T-cell-rich or diffuse, more aggressive); Relapsed nodular lymphocyte-predominant Hodgkin lymphoma (rituximab-based); Transformation to T-cell/histiocyte-rich large B-cell lymphoma
- Biomarkers: CD20-positive, CD30- and CD15-negative LP cells with OCT2 and PAX5 expression; Fan growth pattern (A to F) on the biopsy; Absence of EBV; Stage and number of nodal sites; Lactate dehydrogenase and B symptoms (transformation suspicion); FDG-PET (staging; avid)

## Standard of care

- Diagnosis: 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. ([Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [FDG PET](https://onco.cc/technologies/fdg-pet/), [Lugano classification / Ann Arbor staging](https://onco.cc/terms/lugano-classification/), [Lymphoma (tissue type)](https://onco.cc/terms/lymphoma-type/))
- Stage IA without risk factors: Involved-site radiotherapy alone (30 Gy); in children, complete excision followed by observation. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Active surveillance](https://onco.cc/technologies/active-surveillance/), [Children's Oncology Group (COG)](https://onco.cc/institutions/childrens-oncology-group/))
- Stage IB to IV: ABVD or rituximab-containing chemotherapy (R-CHOP, R-CVP, R-ABVD) with or without involved-site radiotherapy; rituximab alone for frail patients. ([Rituximab](https://onco.cc/drugs/rituximab/), [R-CHOP (lymphoma chemoimmunotherapy)](https://onco.cc/terms/r-chop/), [ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)](https://onco.cc/terms/abvd-beacopp/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Vincristine](https://onco.cc/drugs/vincristine/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- Relapse: Rebiopsy to exclude transformation; rituximab alone or with chemotherapy, radiotherapy for localised relapse; autologous transplantation only for early or repeated relapse. ([Rituximab](https://onco.cc/drugs/rituximab/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- Transformation: Treat as diffuse large B-cell lymphoma with R-CHOP. ([R-CHOP (lymphoma chemoimmunotherapy)](https://onco.cc/terms/r-chop/), [Rituximab](https://onco.cc/drugs/rituximab/))

## State of the art

- Radiotherapy alone or excision cures most early-stage patients with minimal toxicity.
- Rituximab, useless in classical Hodgkin lymphoma, is active here because the cells are CD20-positive.
- The 2022 renaming reflects a disease now understood as an indolent B-cell lymphoma.

## Open problems

- No randomised trial has compared ABVD with rituximab-based chemotherapy.
- Variant growth patterns are hard to reproduce between pathologists.
- Late relapse and transformation over decades make lifelong follow-up necessary.
- The rarity of the disease limits every study to retrospective series.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Nodular_lymphocyte_predominant_Hodgkin_lymphoma
- NCCN Hodgkin Lymphoma: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1439
- Wikipedia: https://en.wikipedia.org/wiki/Nodular_lymphocyte_predominant_Hodgkin_lymphoma

## Connected records

- cancers: [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [FDG PET](https://onco.cc/technologies/fdg-pet/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- drugs: [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Dacarbazine](https://onco.cc/drugs/dacarbazine/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Rituximab](https://onco.cc/drugs/rituximab/), [Vinblastine](https://onco.cc/drugs/vinblastine/), [Vincristine](https://onco.cc/drugs/vincristine/)
- terms: [ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)](https://onco.cc/terms/abvd-beacopp/), [Lugano classification / Ann Arbor staging](https://onco.cc/terms/lugano-classification/), [Lymphoma (tissue type)](https://onco.cc/terms/lymphoma-type/), [R-CHOP (lymphoma chemoimmunotherapy)](https://onco.cc/terms/r-chop/)
- key papers: [Long-term follow-up of nodular lymphocyte-predominant Hodgkin lymphoma treated in the GHSG HD7 to HD15 trials](https://onco.cc/key-papers/paper-eichenauer-nlphl-ghsg-hd7-hd15-long-term-jco-2020/), [WHO classification of haematolymphoid tumours, fifth edition: lymphoid neoplasms](https://onco.cc/key-papers/paper-who-2022-lymphoid-alaggio-leukemia-2022/)
- institutions: [Children's Oncology Group (COG)](https://onco.cc/institutions/childrens-oncology-group/)

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