How I treat nodular lymphocyte-predominant Hodgkin Lymphoma

Lymphoma
03/09/2020

Blood. 2020 Sep 2:blood.2019004044. doi: 10.1182/blood.2019004044. Online ahead of print.

ABSTRACT

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma entity with distinct pathological and clinical characteristics. Unlike the malignant cells in classical Hodgkin lymphoma, the disease-defining lymphocyte predominant cells in NLPHL are consistently positive for CD20 but do not express CD30. The clinical course of NLPHL is indolent in the majority of cases. Most patients present with early-stage disease at initial diagnosis. First-line treatment for stage IA NLPHL usually


consists of limited-field radiotherapy (RT) alone. Patients with early-stage NLPHL other than stage IA and intermediate-stage disease mostly receive combined-modality treatment whereas individuals with advanced NLPHL are treated with chemotherapy alone. In relapsed NLPHL, conventional chemotherapy, anti-CD20 antibodies and RT represent active treatment modalities. Only patients with poor-risk characteristics such as early disease recurrence are candidates for aggressive salvage treatment with high-dose chemotherapy and autologous stem cell transplantation. The overall and relative survival of patients with NLPHL is excellent as indicated by a low excess mortality in comparison with the general population. In this article, we discuss treatment options for patients with NLPHL and factors that influence the choice of therapy on the basis of the available data and two clinical cases.