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Click here to download our Understanding Hodgkin Lymphoma bookletClick here to download a copy of the NLPHL factsheetOverview of Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) is a very rare subtype of Hodgkin lymphoma which accounts for around 5% of Hodgkin lymphoma cases each year. NLPHL is slower growing in nature to the more common subtypes of HL which are more aggressive (fast growing) in nature. NLPHL resembles some of the indolent non-Hodgkin lymphomas as it is more chronic in nature and has long remission periods but respond very well to treatment. Usually the only sign of NLPHL is a painless lump in the neck, armpit or groin area that does not go away over time. These are enlarged lymph nodes that swell due to the lymphoma. In NLPHL they are often only in one area of the body. Some patients also report fatigue (tired and lacking energy). Who is affected?This subtype is more common in people aged between 30 to 50 years. It is around three times more common in men than women. It can also affect all ages, including younger adults. There are four other subtypes of Hodgkin lymphoma that behave more aggressively and are treated differently to NLPHL. For more information on the other subtypes see classical Hodgkin lymphoma. Treatment and prognosisNLPHL is diagnosed by having a lymph node biopsy and the treatment for NLPHL will work very well in most cases . If NLPHL is in only one place or the lumps are close together the only treatment needed might be surgery to remove the lumps. Some patients may also have radiotherapy to the affected area. More widespread (advanced) NLPHL will be monitored and chemotherapy may be needed. If the NLPHL relapses (comes back), treatment is usually successful again. What are the symptoms of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL)?Usually the only sign of NLPHL is a painless lump in the neck, armpit or groin area that does not go away over time. Some patients also report fatigue (tired and lacking energy). B symptoms can include the following symptoms:
Diagnosis & StagingA biopsy is always required for a diagnosis of NLPHL. A biopsy is a surgical procedure to remove part of or all of an affected lymph node or other abnormal tissue to look at it under the microscope by a pathologist to see what the cells look like. The biopsy can be done under local or general anaesthetic depending on what part of the body is being biopsied. The biopsy can be one of three ways:
An excisional node biopsy is the best investigative option, as it collects the most adequate amount of tissue to be able to do the necessary testing for a diagnosis. Waiting for test results can be a difficult time. It may help to talk to your family, friends or a specialist cancer nurse. For more info seeDiagnosis & StagingStagingOnce a diagnosis of NLPHL is made, further tests are required to see if the lymphoma is in other parts of the body. This is called staging. The staging of your lymphoma helps your doctor to know what the best treatment for the patient. There are four stages from stage 1 (lymphoma in one area) through to stage 4 (lymphoma that is widespread).
 What is the ‘grade’ of lymphoma?Lymphomas are also often grouped as either indolent or aggressive. Indolent lymphomas are usually slow growing and aggressive lymphomas are fast growing. The grade is also referred to as the clinical behaviour of the lymphoma. NLPHL is an indolent lymphoma. Staging scans and testsThe scans and tests needed for staging and before treatment can start may include:
Patients may also undergo a number of baseline tests prior to any treatment commencing to check organ functions. These are often repeated during and after the treatment has completed to assess whether the treatment has affected the functioning of organs. Sometimes the treatment and follow-up care may need to be adjusted to help manage side effects. These may include:
It may take some time for all the necessary biopsies and tests to be done (an average of 1-3 weeks), but it is important for the doctors to have a complete picture of the lymphoma and the general health of the patient in order to make the best treatment decisions Many of the staging and organ function tests are done again after treatment to check whether the lymphoma treatment has worked and the effect this has had on the body. For more info seeStaging scans & TestsIt is important to note that lymphoma is what is known as a systemic cancer. It can spread throughout the lymphatic system and nearby tissue and organs. Many patients are diagnosed at an advanced stage, unlike advanced stage solid tumour cancers, such as bowel or lung cancer. Prognosis of NLPHLNLPHL is a highly treatable lymphoma with standard first-line treatment and up to 90 percent of patients are cured or have a long remission period ( 10 years or longer at a time). Treatment for nodular lymphocyte predominant Hodgkin lymphoma (NLPHL)Once all the results from the biopsy and the staging scans have been completed, the doctor will review these to decide the best possible treatment for a patient. At some cancer centres, the doctor will also meet with a team of specialists to discuss the best treatment and this is called a multidisciplinary team (MDT)meeting. Doctors take into consideration many factors about the lymphoma and the patient’s general health to decide when and what treatment is required. This is based on:
If treatment is needed, the patient’s type and severity of the symptoms, age, overall health and degree of the thickness of the blood, will help determine which treatment is selected. The standard first line treatments may include (for adult hospitals): Early Stage NLPHL without B symptomsRadiotherapy alone Surgery followed by radiotherapy Surgery alone Early Stage NLPHL with B symptomsChemotherapy and monoclonal antibody *CVP-R x 2-3 cycles followed by radiotherapy Chemotherapy and monoclonal antibody CVP-R x 6 cycles Advanced Stage NLPHLChemotherapy and monoclonal antibody *CHOP-R x 6 cycles Chemotherapy and monoclonal antibody *ABVD-R x 6 cycles Chemotherapy and monoclonal antibody CVP-R x 6 cycles
Children and Young AdultsCommon side effects of treatmentThere are many different side effects of the treatment and these are dependent on the treatment that has been given. The treating doctor and/or cancer nurse can explain the specific side effects prior to the treatment. Some of the more common side effects of treatment may include:
The medical team, doctor, cancer nurse or pharmacist, should provide information about:
Side effects of treatmentFertility preservationSome treatments for lymphoma can reduce fertility and this is more likely with certain chemotherapy regimens (combinations of drugs) and high-dose chemotherapy used before a stem cell transplant. Radiotherapy to the pelvis also increases the likelihood of reduced fertility. Some antibody therapies may also affect fertility, but this is less clear. The doctor should advise on whether fertility may be affected and if fertility preservation should be considered before treatment starts (if this is an option). Follow-up careOnce treatment has completed, post treatment staging scans are done to review how well the treatment has worked. The scans will show the doctor if there has been a:
If all goes well regular follow-up appointments will be made for every 3-6 months to monitor the below:
These appointments are also important so that the patient can raise any concerns that they may need to discuss with the medical team. A physical examination and blood tests are also standard tests for these appointments. Apart from immediately after treatment to review how the treatment has worked, scans are not usually done unless there is a reason for them. For some patient’s appointments may become less frequent over time. Relapsed or refractory NLPHL treatmentNodular lymphocyte predominant Hodgkin lymphoma (NLPHL) usually responds very well to chemotherapy, but in some patients the lymphoma comes back (relapses after a period of remission) or in rare cases does not respond to initial first-line treatment (refractory or does not respond to treatment) There are other treatments (second-line) that can work well and can include:
If a relapse is suspected another biopsy need to be done often with the same staging tests that were explained above in the staging section. For more info seeRelapsed and Refractory LymphomaTreatment under investigationThere are many treatments that are currently being tested in clinical trials around the world and in Australia for patients with both newly diagnosed and relapsed lymphoma. For the most current treatments see the Nodular Lymphocyte Predominant Hodgkin Lymphoma Fact SheetFor more info seeClinical trialsWhat happens after treatment?Late EffectsSometimes a side effect from treatment may continue or develop months or years after treatment has completed. This is called a late effect. Finishing treatmentThis can be a challenging time for many people and some of the common concerns can be related to:
Finishing TreatmentHealth and wellbeingA healthy lifestyle, or some positive lifestyle changes after treatment can be a great help after the treatment has been finished. Making small changes such as eating and increasing fitness can improve health and wellbeing and help the body to recover. There are many self-care strategies that can help during the recovery phase. For more info seeHealth & WellbeingWhat is nodular lymphocyteNodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare type of Hodgkin lymphoma (HL) that tends to grow more slowly than classic HL (cHL). It's often treated differently. For people with early-stage NLPHL without any B symptoms, involved site radiation therapy (ISRT) is often all that's needed.
Is nodular lymphocyte curable?NLPHL usually affects people aged 30 to 50 years old and is more common in men than women. NLPHL is curable, but people may relapse years after complete remission. Very rarely, NLPHL can progress into an aggressive type of NHL called diffuse large B-cell lymphoma.
Is nodular lymphocyteNodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma entity with an incidence of 0.1 to 0.2/100 000/y. Compared with the more common subtypes of classical Hodgkin lymphoma, NLPHL is characterized by distinct pathological and clinical features.
Is nodular lymphoma cancerous?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.
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What is nodular lymphocyte predominant hodgkin lymphoma
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