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Classical vs nodular lymphocyte-predominant Hodgkin lymphoma | CION Cancer Clinics
Classical Hodgkin lymphoma makes up about 95% of Hodgkin lymphoma, and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) about 5%. They look alike at first, but the abnormal cells carry different markers. NLPHL usually grows slowly and is often treated with less, sometimes radiotherapy alone or careful watching. Classical Hodgkin usually needs combination chemotherapy. Here is how to read the difference on your report. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is the difference between classical and NLP Hodgkin lymphoma?
- How do the two types compare?
- How is each type usually treated?
- How does the lab tell them apart?
- What happens between the biopsy and a treatment plan?
- What do families often get wrong about the two types?
- What can this page not tell you?
- Common questions about classical and NLP Hodgkin lymphoma
The short answer
What is the difference between classical and NLP Hodgkin lymphoma?
Classical Hodgkin lymphoma is the common form, making up about 95% of Hodgkin lymphoma. Nodular lymphocyte-predominant Hodgkin lymphoma, written NLPHL on many reports, is the rare form. It makes up about 5%, usually grows slowly and is often treated more gently.
Why two diseases share one name
Both start in the lymph nodes, the small glands in the neck, armpit, chest and groin that filter lymph fluid. Both were first grouped together because a pathologist sees a few large abnormal cells scattered among many normal immune cells. Closer testing shows the abnormal cells are different in each. In classical Hodgkin they are Reed-Sternberg cells. In NLPHL they are "popcorn" cells, named for their folded shape.
What that means for you
The two forms behave differently, spread differently and are treated differently. A plan written for one is not automatically right for the other. That is why the exact type on the biopsy report, the lab report on the removed tissue, matters as much as the stage.
Some newer reports call NLPHL "nodular lymphocyte predominant B-cell lymphoma". It is the same disease with an updated name.Side by side
How do the two types compare?
Classical Hodgkin lymphoma
NLPHL
Classical: the common form, seen in teenagers, young adults and older adults
NLPHL: rare, more often in men in their thirties and forties
Classical: abnormal cells carry the markers CD30 and usually CD15
NLPHL: abnormal cells carry CD20 and lack CD30 and CD15
Classical: often found in the chest and neck, can spread in an orderly way
NLPHL: often a single node area in the neck, armpit or groin
Classical: usually treated with combination chemotherapy, sometimes radiotherapy
NLPHL: early disease may be treated with radiotherapy alone or watched
Classical: can come back, usually within the first few years
NLPHL: can come back late, and rarely changes into a faster lymphoma
Treatment in outline
How is each type usually treated?
These are broad patterns. Your own plan depends on the stage, your age, your other health conditions and what your haematologist finds.
Classical, early stage
Usually a short course of combination chemotherapy such as ABVD, with or without radiotherapy to the area involved. A PET-CT scan partway through often guides whether radiotherapy is needed.
Classical, advanced stage
A longer course of chemotherapy. Newer medicines such as brentuximab vedotin, a targeted drug aimed at CD30, are used in some plans.
Not suited to everyone. Existing nerve or lung problems change the choice.NLPHL, one area only
Often radiotherapy to that one area. If the node was fully removed at biopsy, some people are closely watched instead.
NLPHL, more widespread
Rituximab, a drug aimed at CD20, alone or with chemotherapy. Some people without symptoms are watched for a time before any treatment starts.
Watching suits people who
- Have no fevers, sweats or weight loss
- Can attend regular check-ups
Not sure whether this applies to you?
Ask an oncologistReading the report
How does the lab tell them apart?
The lab tells them apart with special stains on the tissue, called immunohistochemistry or IHC. Each stain shows whether a marker protein sits on the abnormal cells. The pattern of markers, not the look of the cells alone, settles the type.
Why a whole node is often needed
In both types the abnormal cells are few, often less than one in a hundred cells in the sample. A thin needle sample may miss them or show too little of the node's structure. Many haematologists prefer the surgeon to remove a whole node, or take a larger core of tissue, so the pathologist can see the nodular pattern that NLPHL shows.
When the answer is not clear-cut
NLPHL can look like a type of non-Hodgkin lymphoma called T-cell/histiocyte rich large B-cell lymphoma. Classical Hodgkin can look like some other lymphomas too. If your report uses words such as "favour" or "cannot exclude", a second review by a specialist lymphoma pathologist is reasonable. Ask your team whether the slides and blocks can be sent for one.
The pathway
What happens between the biopsy and a treatment plan?
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The biopsy
A surgeon removes a lymph node, or takes a core of tissue, usually under local or general anaesthetic. You normally go home the same day.
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The pathology report
The pathologist stains the tissue and names the type. Extra stains can take several more days, so a first report may say "further stains to follow".
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Staging tests
A PET-CT scan and blood tests show how many areas are involved. For NLPHL the scan also helps judge whether watching is safe.
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Tumour board discussion
At CION the case is presented to a tumour board, a meeting of specialists, before a plan is confirmed. Where a test or treatment is not done in-house, the team coordinates it with a qualified centre.
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The plan is explained
Ask which type you have, what stage, what is recommended and why. Bring the family member who will help you decide.
Commonly believed
What do families often get wrong about the two types?
"Hodgkin is Hodgkin. The type does not change anything."
It changes a great deal. NLPHL is often treated with less chemotherapy, or with radiotherapy alone, while classical Hodgkin usually needs combination chemotherapy. Getting the type right avoids both under-treatment and treatment you did not need.
"If the doctor says 'let us watch it', nothing is being done."
Watching is an active plan for some people with NLPHL. It means regular examinations and scans, with treatment started if the disease grows or symptoms appear. It avoids side effects while they are not needed.
"Slow-growing means we can take our time with the biopsy report."
The report still needs a prompt review. Until the type is confirmed, nobody knows it is the slow form. Do not delay the appointment where results are explained.
"Classical Hodgkin is the more serious one, so NLPHL needs no follow-up."
NLPHL can return many years later, and rarely changes into a faster-growing lymphoma. Long-term follow-up matters for both types.
Being straight with you
What can this page not tell you?
This page cannot tell you which type you have, or what your outlook is. Both depend on the tissue itself, the stage, your age, your blood tests and how the disease responds to treatment. Your haematologist puts those together.
Questions worth taking to the appointment
Which type does my report show, and how sure is the pathologist? Were the markers CD30, CD15 and CD20 tested? Would a second review of the slides help? What stage is it, and does my plan include chemotherapy, radiotherapy, a targeted drug or a period of watching? Who does this plan not suit, and why is it right for me?
Write the answers down, or ask whether a family member can record them on a phone.Questions we are asked
Common questions about classical and NLP Hodgkin lymphoma
Is NLPHL less serious than classical Hodgkin lymphoma?
NLPHL usually grows more slowly and is often found early, so treatment is frequently lighter. That does not make it harmless. It can come back late and rarely turns into a faster lymphoma. How serious it is for you depends on the stage and your health, which your haematologist will explain.
My report says CD30 positive. What does that mean?
CD30 is a marker protein on the surface of the abnormal cells. It is typical of classical Hodgkin lymphoma and usually absent in NLPHL. It also matters for treatment, because brentuximab vedotin targets cells carrying CD30. A single marker is read alongside the others, never on its own.
Can the type change after diagnosis?
Classical Hodgkin does not become NLPHL, or the other way round. What can happen, rarely, is that NLPHL changes into a faster-growing B-cell lymphoma. If the disease returns or behaves differently, a fresh biopsy is often advised so the team treats what is there now.
Why did the doctor want a whole lymph node removed?
The abnormal cells are sparse, and the pattern of the node helps tell the two types apart. A fine needle sample often cannot show that. Removing a whole node gives the pathologist enough tissue to name the type with confidence, which shapes every decision after it.
Is watching without treatment safe for NLPHL?
For some people with slow, symptom-free NLPHL it is a recognised option. It suits people who can keep regular check-ups and scans. It does not suit anyone with fevers, drenching sweats, weight loss or disease pressing on an organ. Your haematologist decides this with you, not in advance.
Does either type run in families?
Close relatives of someone with Hodgkin lymphoma have a slightly higher chance of it, but the risk to any one relative stays low. There is no routine screening test for family members. If a relative has lasting swollen glands, fevers or sweats, they should see a doctor as they normally would.
Should I get a second opinion on the pathology?
It is reasonable when the report is uncertain, uses words such as "suggestive of", or the type does not fit how the illness is behaving. The slides and tissue blocks can usually be sent for review. Ask your treating team; asking will not offend a good team.
Are treatment costs covered by Aarogyasri or insurance?
Lymphoma treatment is often covered, in full or in part, under Aarogyasri, PM-JAY, CGHS, ECHS, EHS or cashless insurance, depending on your eligibility. Scheme rules change, so check the current rules for your card or policy. The CION team can help you understand what applies to you.
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Sources
- American Cancer Society — What Is Hodgkin Lymphoma?
- Cancer Research UK — Types of Hodgkin lymphoma
- National Cancer Institute — Hodgkin Lymphoma Treatment (PDQ) - Patient Version
- Leukemia & Lymphoma Society — Hodgkin Lymphoma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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Share the biopsy report with us. CION's haematology team will read it with you and explain what the next step is. One helpline serves every CION centre.