Nodular lymphocyte-predominant Hodgkin’s lymphoma

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Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL) is a subtype of Hodgkin’s lymphoma. This type of cancer starts in the lymphocytes, a type of white blood cell.

Typically, people with Hodgkin’s lymphoma have hallmark tumor cells known as Reed-Sternberg cells.

Few Reed-Sternberg cells are present in people with NLPHL. Instead, people with NLPHL develop other abnormal cells that doctors call popcorn cells because they resemble popcorn.

NLPHL is rare. It occurs in about 0.1 to 0.2 out of 100,000 people and affects about 5% of people with Hodgkin’s lymphoma.

NLPHL usually starts in the lymph nodes under the arm and neck. Symptoms may vary in severity at first but can include painless swollen lymph nodes in the neck or under the arms.

Other symptoms, known as B symptoms, may include:

• fever
• night sweats
• weight loss

However, these additional symptoms are less common because NLPHL tumor cells are not a source of proinflammatory cytokines. Only about 6–15% of people with NLPHL report B symptoms.

Doctors rely on medical history, physical exams, lab tests, and positron emission tomography scans (PET) to diagnose NLPHL.

Taking a biopsy of an enlarged lymph node and checking it for cancer cells confirms the diagnosis.

Once doctors make a diagnosis, they move on to staging the disease. Staging can help determine the treatment plan.

Staging for NLPHL takes into account the following:

• the presence of B symptoms
• biopsy results
• whether the cancer has spread throughout the body

Generally, the outlook for people with NLPHL is favorable. The disease tends to grow slowly and is curable.

However, the exact outlook depends on the cancer stage at diagnosis.

Treatment often depends on the stage of the disease at diagnosis.

For example, people with no B symptoms and early stage disease may only require targeted radiation therapy of the affected lymph nodes.

Doctors may also recommend a wait-and-see approach for people who have no symptoms. This approach involves monitoring the lymphoma closely and starting treatment when symptoms arise.

In people with early stage NLPHL, treatment typically begins when B symptoms start and involves chemotherapy followed by radiation therapy.

For advanced stage NLPHL, treatment may involve chemotherapy, radiation therapy, and rituximab, a monoclonal antibody that targets specific cancer cells.

Relapsed NLPHL refers to cancer that returns after successful treatment.

Refractory NLPHL means the cancer did not respond to treatment. Treatment may not have destroyed the cancer cells, or the cancer may have continued to grow even with treatment.

Here are answers to some frequently asked questions about NLPHL.

What is nodular lymphocyte-predominant Hodgkin’s lymphoma?

Nodular lymphocyte-predominant Hodgkin’s lymphoma is a type of cancer of the white blood cells.

What is the survival rate for nodular lymphocyte-predominant Hodgkin’s lymphoma?

Nodular lymphocyte-predominant Hodgkin’s lymphoma has a 10-year survival rate of over 90%.

What is the treatment for nodular lymphocyte-predominant Hodgkin’s lymphoma?

Radiation therapy is the first-line treatment for asymptomatic nodular lymphocyte-predominant Hodgkin’s lymphoma.

If symptoms develop, treatment usually includes chemotherapy and radiation therapy. Doctors may prescribe different combinations of chemotherapy medications depending on the stage of the disease.

What age is nodular lymphocyte-predominant Hodgkin’s lymphoma?

Nodular lymphocyte-predominant Hodgkin’s lymphoma can develop at any age. However, it occurs most often in people 30–50 years of age.

NLPHL is a type of cancer affecting the white blood cells. It is a rare subtype of classic Hodgkin’s lymphoma.

NLPHL tends to progress slower than classic Hodgkin’s lymphoma and is curable. Symptoms typically start with swollen lymph nodes in the neck or under the arms. Treatment may include radiation therapy and chemotherapy.