Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more
Pathologists currently use the World Health Organization (WHO) modification of
the Revised European-American Lymphoma (REAL) classification for the histologic
classification for adult Hodgkin’s lymphoma (HL).[1,2]
- Classical HL.
- Nodular sclerosis HL.
- Mixed-cellularity HL.
- Lymphocyte depletion HL.
- Lymphocyte-rich classical HL.
- Nodular lymphocyte–predominant HL.
Nodular lymphocyte–predominant HL is a clinicopathologic entity
of B-cell origin that is distinct from classic HL.[3,4,5] The
typical immunophenotype for lymphocyte-predominant disease is CD15-, CD20+,
CD30-, CD45+, while the profile for classic HL is CD15+, CD20-,
CD30+, CD45-. Patients with lymphocyte-predominant disease have earlier-stage
disease, longer survival, and fewer treatment failures than those with classic
HL. Lymphocyte-predominant HL is usually
diagnosed in asymptomatic young males with cervical or inguinal lymph nodes
but usually without mediastinal involvement.
The REAL Classification of
Lymphoid Neoplasms proposed separating nodular lymphocyte–predominant HL (CD15-, CD20+, CD30-) from lymphocyte-rich classical HL
(CD15+, CD20-, CD30+), on the basis of these immunophenotypic
differences.[2,6] The largest retrospective report of 426 cases showed no
significant difference in clinical response or outcome to standard therapies
for these two subgroups.[Level of evidence: 3iiiA] Of interest, with a median
follow-up of 7 to 8 years, more patients died of treatment-related toxic
effects (acute and long-term) than from Hodgkin’s recurrence. Limitation of
radiation dose and fields and avoidance of leukemogenic chemotherapeutic
agents, along with watchful waiting policies, should be investigated for these
Lukes RJ, Craver LF, Hall TC, et al.: Report of the Nomenclature Committee. Cancer Res 26 (1): 1311, 1966.
Harris NL: Hodgkin's lymphomas: classification, diagnosis, and grading. Semin Hematol 36 (3): 220-32, 1999.
von Wasielewski R, Mengel M, Fischer R, et al.: Classical Hodgkin's disease. Clinical impact of the immunophenotype. Am J Pathol 151 (4): 1123-30, 1997.
Bodis S, Kraus MD, Pinkus G, et al.: Clinical presentation and outcome in lymphocyte-predominant Hodgkin's disease. J Clin Oncol 15 (9): 3060-6, 1997.
Orlandi E, Lazzarino M, Brusamolino E, et al.: Nodular lymphocyte predominance Hodgkin's disease: long-term observation reveals a continuous pattern of recurrence. Leuk Lymphoma 26 (3-4): 359-68, 1997.
Shimabukuro-Vornhagen A, Haverkamp H, Engert A, et al.: Lymphocyte-rich classical Hodgkin's lymphoma: clinical presentation and treatment outcome in 100 patients treated within German Hodgkin's Study Group trials. J Clin Oncol 23 (24): 5739-45, 2005.
Diehl V, Sextro M, Franklin J, et al.: Clinical presentation, course, and prognostic factors in lymphocyte-predominant Hodgkin's disease and lymphocyte-rich classical Hodgkin's disease: report from the European Task Force on Lymphoma Project on Lymphocyte-Predominant Hodgkin's Disease. J Clin Oncol 17 (3): 776-83, 1999.
Aster JC: Lymphocyte-predominant Hodgkin's disease: how little therapy is enough? J Clin Oncol 17 (3): 744-6, 1999.
Pellegrino B, Terrier-Lacombe MJ, Oberlin O, et al.: Lymphocyte-predominant Hodgkin's lymphoma in children: therapeutic abstention after initial lymph node resection--a Study of the French Society of Pediatric Oncology. J Clin Oncol 21 (15): 2948-52, 2003.