Nodular lymphocyte-predominant Hodgkin lymphoma

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was reviewed on May 26, 2022.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare type of blood cancer. It occurs when lymphocytes, a type of white blood cell in the immune system, behave abnormally. Specifically, NLPHL occurs in B lymphocytes.

There are different types of lymphoma: Hodgkin or non-Hodgkin lymphoma. NLPHL is the Hodgkin type, which means Reed-Sternberg cells are present. These are large cancerous cells found in lymph fluid. The word nodular in NLPHL means the lymphoma grows in the lymph nodes. NLPHL differs from other types of Hodgkin lymphoma due to its unique pathology, which can be examined by doctors under a microscope.

This cancer type is slow-growing and not common. NLPHL accounts for about 5 percent of all Hodgkin lymphoma cases, according to data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program cited in the Journal of Clinical Oncology.

What causes NLPHL?

NLPHL develops when genetic mutations affect genes within the B lymphocytes.

Researchers are unsure about the exact causes of Hodgkin lymphoma and NLPHL. Some evidence suggests that the Epstein-Barr virus, formally known as human gammaherpesvirus 4, can cause DNA changes to B lymphocytes, which in turn can produce Reed-Sternberg cells.

DNA changes to the genes may play a role in NLPHL, but more research is needed.

NLPHL risk factors

Hodgkin lymphoma risk factors include age (adults in their 20s or older than 55) and gender (male), according to the American Cancer Society. In the case of NLPHL specifically, the Journal of Clinical Oncology study found that 86 percent of 1,937 patients were younger than age 65 and 67 percent were male.

NLPHL symptoms

Symptoms of nodular lymphocyte-predominant Hodgkin lymphoma may include those listed below.

  • Lump in the neck, groin or armpit that doesn’t go away (usually painless)
  • Unexplained fatigue
  • Excessive nighttime sweating
  • Weight loss
  • Ongoing high fevers

Fever, night sweats and weight loss are classified as “B symptoms” in Hodgkin lymphoma patients, as these symptoms can also be caused by other health issues. Always check with the care team about any concerns regarding unexpected changes in the body.

NLPHL diagnosis and detection

NLPHL is diagnosed via biopsy, a surgical procedure where all or part of a lymph node is removed and examined under a microscope to look for evidence of cancer cells. The type of biopsy used varies, based on the location of the lymph node, but either local or generalized anesthetic will be used to minimize discomfort.

If cancer is found, the care team may order additional tests to determine the stage, grade and type. These may include:

NLPHL stages

Early: Known as stage 1 or 2, this cancer type is generally localized or found in several nearby areas of the body.

Advanced: Stage 3 or 4 NLPHL has spread to parts of the body distant from the original cancer.

NLPHL grades

Lymphomas can be either indolent or aggressive. NLPHL is an indolent lymphoma type, meaning it typically grows slowly.

NLPHL treatment

The patient's care team will discuss appropriate treatment options with the patient, taking into account the following factors:

  • Cancer stage and type
  • Personal preferences
  • Age and overall health
  • Whether or not the patient wants to have children in the future
  • Symptoms

For early-stage patients without B symptoms, site radiation therapy is the most common treatment—and it may be the only treatment needed. It’s also called external beam therapy and uses external radiation beams to specifically target the tumor.

If the NLPHL is advanced, chemotherapy is the most common treatment. In some patients, chemotherapy is given and then followed with radiation.

Chemotherapy is a treatment that uses medication to kill cancer cells. A number of different chemotherapy drugs can be used for NLPHL, and sometimes several are combined together.

Nodular lymphocyte predominant Hodgkin lymphoma survival rate

Because NLPHL is a rare type of lymphoma, survival statistics are based on small case studies. One study of 73 people with nodular lymphocyte predominant Hodgkin lymphoma found that overall 10-year survival was 94 percent, and 10-year progression-free survival was nearly 76 percent.

Keep in mind that the survival rate for NLPHL depends on a variety of factors, including the patient’s age, overall health and the extent of the disease, so the patient should always talk to his or her care team about his or her individual prognosis.

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