Nodular Lymphocytic Predominant Hodgkin Lymphoma (NLPHL) (bsh 2015)
CD45+, CD20+, CD79a+, PAX-5+, OCT-2+, BCL6+, BOB-1+, PU-1+, BTK+, EMA+
CD10-, CD30-, CD15-
Rare disease. 5% of Hodgkins (HL) in adults. 10-20% of HL in children.
3:1 Male to Female ratio
Usually presents as early stage, non-bulky disease with few adverse risk factors
Favourable prognosis, indolent course
5% transformation to DLBCL (outcome is same as de novo DLBCL, ie OS 60% at 10 years)
No prospective randomized controlled trials to compare treatments.
B cell neoplasm characterized by CD20+ lymphocyte predominant (LP) or popcorn cells.
cHL is CD30+, CD15+, MUM1+, CD45-, CD20-, CD79a-, CD19-
Nodular or nodular and diffuse lymphoid infiltrate with follicular dendritic cells
‘Popcorn cells’ have scant cytoplasm, polylobated nuclei and distinct nucleoli
Lymphocyte rich classical HL (LRcHL) – need detailed immunophenotyping to separate
Progressive transformation of germinal centres (PTGC) – benign condition
T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) – ?spectrum of same disorder
FBC, ESR, U&E, LFT, LDH, Bone, Immunoglobulins
HIV, Hep B/C
CT or FDG-PET staging (1/3 of patients will be upstaged with PET vs CT)
BM biopsy not required in early disease. Not in advanced if PET performed.
Irradiated blood products flag
No evidence for interim scan at present
CT or PET at end of treatment