What are the NCCN recommendations for treatment of NLPHL?

Updated: Sep 12, 2018
  • Author: Bradley W Lash, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a distinct entity with unique clinical features and a different treatment paradigm. The National Comprehensive Cancer Network (NCCN) prefers involved-site radiation therapy (ISRT) over involved-field radiation therapy (IFRT) for treatment of early-stage favorable NLPHL. (Involved-site fields are generally smaller than classic involved fields.) For early-stage unfavorable or advanced-stage NLPHL, an ABVD regimen (doxorubicin [Adriamycin]/bleomycin/vinblastine/dacarbazine) plus ISRT is recommended. CHOP (cyclophosphamide, doxorubicin [hydroxydaunorubicin], vincristine [Oncovin], and prednisone) may also be used. [4]

Rituximab may be considered in combination with ABVD or CHOP. For refractory disease, maintenance rituximab may be considered. Individualized treatment is recommended. At relapse, patients biopsy should be performed due to the high rate of conversion to aggressive B-cell lymphoma. [4]

ESMO recommends IFRT for treatment of patients with stage IA NLPHL who have no risk factors. For early-stage unfavorable or advanced stage disease, the treatment recommendation is identical to that for CHL. [5]

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