Nodular lymphocyte-predominant Hodgkin lymphoma: current management strategies and evolving approaches to individualize treatment.

Stage IA NLPHL without clinical risk factors should be treated with limited-field radiotherapy alone. In all other stages, NLPHL patients have excellent outcomes after standard HL approaches. The question of whether the addition of an anti-CD20 antibody to standard HL chemotherapy protocols or the use of approaches typically applied in B-cell non-Hodgkin lymphoma improve treatment results is unanswered until now. Different management strategies ranging from low-intensity treatment to high-dose chemotherapy and autologous stem cell transplantation have demonstrated activity in relapsed NLPHL. Second-line treatment is thus chosen individually. The major aim of NLPHL research is to spare toxicity and reduce the risk for treatment-related adverse events in low-risk patients while treating higher-risk patients with appropriate intensity. To this end, novel tools to guide treatment are required.