Treatments for nodular lymphocyte-predominant Hodgkin lymphoma

Last medical review: July 2025

The following are treatment options for nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Active surveillance

Active surveillance may be an option for early-stage NLPHL. Your healthcare team will use tests and exams to watch the cancer closely. Rather than giving treatment that may cause side effects, they wait to see if NLPHL is growing or spreading. Other treatment is given when you develop symptoms or the cancer changes.

Radiation therapy

The type of radiation therapy used for NLPHL is external radiation therapy (also called external beam radiation therapy). A machine directs high-energy rays or particles through the skin to destroy cancer cells. The healthcare team can use the following techniques to direct radiation to the cancer and avoid affecting healthy tissue.

Involved-site radiation therapy (ISRT) is given only to the lymph nodes where the NLPHL started and a very small amount of nearby tissue. It is offered for early-stage NLPHL.

Involved-field radiation therapy (IFRT) is given to a larger area of tissue around the lymph nodes. It may be given after chemotherapy or by itself to treat advanced NLPHL. Sometimes IFRT can be used to treat NLPHL that didn't respond to treatment (refractory NLPHL) or NLPHL that has come back after treatment (relapsed NLPHL) if the area hasn’t already been treated with radiation therapy.

Find out more about radiation therapy for Hodkgin lymphoma.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. It is used to treat advanced, relapsed and refractory NLPHL. It is not used to treat early-stage disease.

The following chemotherapy combinations may be given for NLPHL:

CHOP – cyclophosphamide, doxorubicin, vincristine and prednisone
CVP – cyclophosphamide, vincristine and prednisone
ABVD – doxorubicin, bleomycin, vinblastine and dacarbazine

Find out more about chemotherapy for Hodgkin lymphoma.

Immunotherapy

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. Immunotherapy is used for advanced, relapsed and refractory NLPHL. It may be given alone or with combination chemotherapy.

Rituximab (Rituxan and biosimilar drugs) is a monoclonal antibody that is used to treat NLPHL. This drug targets the CD-20 antigen, which is found on the lymphocyte-predominant (LP) cells in NLPHL.

Clinical trials

Talk to your doctor about clinical trials open to people with HL in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Joseph Connors, MD, CM

Eichenauer DA, Fuch M. Treatment of nodular lymphocyte-predominant Hodgkin lymphoma: where do we stand? where do we go?. Cancers. 2023: 15: 3310.
Salvaris RT, Allanson BM, Collins G, Cheah CY. Nodular lymphocyte-predominant Hodgkin lymphoma: advances in disease biology, risk stratification, and treatment. Haematologica. 2024: 109(11): 3476-3487.
Younes A, Dogan A, Johnson PWM, Yahalom J, LaCase AS, & Ansell S. Hodgkin lymphoma. Thun MJ, Linet MS, Cerhan JR, Haiman CA, Schottenfeld D, eds.. Schottenfeld and Fraumeni Cancer Epidemiology and Prevention . 12 ed. New York, NY: Oxford University Press; 2023: ch 66.

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