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 lymphatic cancer. It occurs when lymphocytes, a type of white blood cell in your immune system, behave abnormally. Specifically, NLPHL occurs in B lymphocytes.

There are different types of lymphoma: Hodgkin or non-Hodgkin. 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.

Causes of NLPHL

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 our genes may play a role in NLPHL, but there’s still more research to be done.

Risk factors for NLPHL

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.

Symptoms of NLPHL

Symptoms for NLPHL may include:

  • 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 your doctor if you’re concerned about unexpected changes in your body.

Diagnosing NLPHL

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, your doctor 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 grows slowly.

Treating NLPHL

Your care team will discuss appropriate treatment options with you, taking into account the following factors:

  • Cancer stage and type
  • Personal preferences
  • Age and overall health
  • Whether or not you want 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.

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