Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)
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.
Overview
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.
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.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Check before combiningFood and drink: Doxorubicin
Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
- Check before combiningFood and drink: Vincristine
Fatal if given intrathecally: label all syringes.
- Check before combiningLiver: Doxorubicin
Reduce by 50% for bilirubin 20-50 µmol/L and 75% for 50-85 µmol/L.
- Good to knowCardiotoxicity (LVEF decline, cardiomyopathy)
Heart damage from cancer treatment: anthracyclines weaken the heart muscle permanently in a dose-related way, trastuzumab does so reversibly, and some kinase inhibitors raise blood pressure or disturb rhythm. Heart function (LVEF) is monitored by ultrasound during treatment.
- Good to knowHypogammaglobulinaemia and infection risk after B-cell therapies
A shortage of antibodies because treatment has wiped out the B cells or plasma cells that make them, as CD19 CAR-T, CD20 antibodies and BCMA therapies deliberately do. It leaves patients prone to infections, sometimes for years, and is managed with immunoglobulin infusions.
See all on the product pages:CyclophosphamideDoxorubicinRituximabVincristine·Printable cards in the navigator
Anatomy and lymph node drainage
- Bone marrow (leukaemia, MDS, MPN, myeloma)
- Lymph node germinal centre (lymphomas)
- Spleen
- Blood (leukaemic phase)
- Lytic bone lesions (myeloma)
- Skin and extranodal sites
- Nodes: cervical
- Nodes: axillary
- Nodes: mediastinal
- Nodes: para-aortic and mesenteric
- Nodes: inguinal
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.
- Bone marrow (leukaemia, MDS, MPN, myeloma)Variant growth patterns (Fan patterns C to F; T-cell-rich or diffuse, more aggressive) · Transformation to T-cell/histiocyte-rich large B-cell lymphoma
- Lymph node germinal centre (lymphomas)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) · Relapsed nodular lymphocyte-predominant Hodgkin lymphoma (rituximab-based)
- SpleenVariant growth patterns (Fan patterns C to F; T-cell-rich or diffuse, more aggressive)
- Blood (leukaemic phase)
- Lytic bone lesions (myeloma)
- Skin and extranodal sites
- cervical
- axillary
- mediastinal
- para-aortic and mesenteric
- inguinal
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: 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
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 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.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
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.
Subtypes & biomarkers
top- 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
- 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)
How often this target appears
- 1944Jackson and Parker describe the paragranuloma form of Hodgkin disease
- 1966Lukes and Butler define lymphocyte-predominant Hodgkin disease
- 1994REAL classification separates nodular lymphocyte-predominant from classical Hodgkin lymphoma
- 2003Fan describes the six growth patterns that predict behaviour
- 2017Children's Oncology Group shows excision alone is enough for completely resected stage IA disease in children
- 2022WHO renames the disease nodular lymphocyte-predominant B-cell lymphoma
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 7 changes by month →- 2026-09-18This recordNodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)Facts on this page last checked
When this page itself was last checked or edited.
- 2022MilestoneLymphoma (tissue type)WHO renames the disease nodular lymphocyte-predominant B-cell lymphoma
A milestone in how this cancer is treated.
- 2017MilestoneChildren's Oncology Group (COG)Children's Oncology Group shows excision alone is enough for completely resected stage IA disease in children
A milestone in how this cancer is treated.
- 2003MilestoneNodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)Fan describes the six growth patterns that predict behaviour
A milestone in how this cancer is treated.
- 1994MilestoneLymphoma (tissue type)REAL classification separates nodular lymphocyte-predominant from classical Hodgkin lymphoma
A milestone in how this cancer is treated.
- 1966MilestoneNodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)Lukes and Butler define lymphocyte-predominant Hodgkin disease
A milestone in how this cancer is treated.
What is in development for Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
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.
and how the field plans to fix it →What is being done about thisRecurrence and residual diseaseAvailable now- Autologous stem cell transplant (high-dose therapy)Standard of care
In trialsNothing recorded yet.
Ideas and roadmapsNothing recorded yet.
Also on OnCo: Treatment journeys · Survivorship planner.
The rarity of the disease limits every study to retrospective series.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Expert centres
topExpert centres
Bethesda, MD · government | United States | none recorded | 0 | 2,905 | 47,715 | - | |
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Hangzhou · cancer center | China | none recorded | 0 | 1,219 | 17,635 | - | |
Rozzano (Milan) · hospital | Italy | none recorded | 0 | 1,031 | 10,720 | - | |
Changsha · cancer center | China | none recorded | 0 | 930 | 14,477 | - | |
Jinan · cancer center | China | none recorded | 0 | 920 | 7,804 | - | |
Dresden · cancer center | Germany | none recorded | 0 | 728 | 7,984 | - | |
Philadelphia, PA · hospital | United States | none recorded | 0 | 695 | 9,931 | - | |
| United Kingdom | none recorded | 0 | 693 | 7,168 | - | ||
Memphis, TN · cancer center | United States | 0 | 636 | 8,887 | - | ||
Aarhus · hospital | Denmark | none recorded | 0 | 624 | 4,497 | - | |
Freiburg im Breisgau · cancer center | Germany | none recorded | 0 | 549 | 5,261 | - | |
Geneva · hospital | Switzerland | none recorded | 0 | 441 | 6,485 | - | |
Southampton · hospital | United Kingdom | none recorded | 0 | 434 | 3,990 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Nodular lymphocyte-predominant Hodgkin lymphoma but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Nodular lymphocyte-predominant Hodgkin lymphoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example CD20-positive, CD30- and CD15-negative LP cells with OCT2 and PAX5 expression, Fan growth patternon the biopsy, Absence of EBV, Stage and number of nodal sites, Lactate dehydrogenase and B symptoms), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Stage IA nodular lymphocyte-predominant Hodgkin lymphoma, Stage II to IV nodular lymphocyte-predominant Hodgkin lymphoma, Typical nodular growth pattern.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Diagnosis
- For my situation (diagnosis), which of the standard options do you recommend and why?Why: Guideline options include: 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.
Stage IA without risk factors
- For my situation (stage ia without risk factors), which of the standard options do you recommend and why?Why: Guideline options include: Involved-site radiotherapy alone (30 Gy); in children, complete excision followed by observation.
Stage IB to IV
- For my situation (stage ib to iv), which of the standard options do you recommend and why?Why: Guideline options include: ABVD or rituximab-containing chemotherapy (R-CHOP, R-CVP, R-ABVD) with or without involved-site radiotherapy; rituximab alone for frail patients.
- Am I a candidate for Rituximab, Doxorubicin, Cyclophosphamide or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Relapse
- For my situation (relapse), which of the standard options do you recommend and why?Why: Guideline options include: Rebiopsy to exclude transformation; rituximab alone or with chemotherapy, radiotherapy for localised relapse; autologous transplantation only for early or repeated relapse.
- Am I a candidate for Rituximab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Transformation
- For my situation (transformation), which of the standard options do you recommend and why?Why: Guideline options include: Treat as diffuse large B-cell lymphoma with R-CHOP.
- Am I a candidate for Rituximab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Rituximab?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “No randomised trial has compared ABVD with rituximab-based chemotherapy”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Variant growth patterns are hard to reproduce between pathologists”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Nodular lymphocyte-predominant Hodgkin lymphoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
10targets
1drugs
6companies
6institutions
1terms
4key papers
2Every 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.
Latest papers
topQuery 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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