How is early-stage NLPHL treated?

Updated: Sep 12, 2018
  • Author: Bradley W Lash, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Early-stage NLPHL can be treated with local excision, involved-field radiation therapy (IFRT), or expectant management (close observation). [87] Advanced-stage disease may represent histologic transformation to T-cell-rich B-cell lymphoma (TCR-BCL) or diffuse large cell B-cell lymphoma (DLBCL), both of which should be treated with a typical non-Hodgkin regimen such as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone).

Rituximab is a humanized monoclonal antibody that is specific for CD20, a cell-surface antigen expressed by the malignant lymphocytic and histiocytic (L&H) cells in NLPHL. It is a promising agent that has shown activity in NLPHL. On long-term follow-up, the German Hodgkin Lymphoma Study Group observed a 94% overall response rate, with 8 complete remissions, from their population of 15 patients treated with rituximab for relapsed/refractory NLPHL. [88] The use of rituximab in NLPHL, especially in early-stage disease, should ideally be pursued in the context of a clinical trial.

A phase 2 study by Eichenauer et al found that results with rituximab appear inferior when compared with radiotherapy and combined-modality treatment in patients with early-stage NLPHL. However, the authors concluded that investigation of anti-CD20 antibody–based combinations in patients with NLPHL is indicated. [89]

An era-to-era comparison between ABVD treatment and radiotherapy alone found that treating limited-stage NLPHL similar to classical Hodgkin lymphoma may improve outcome compared with the use of radiation alone. [90]

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