My 10-year old son as been diagnosed with NLPHL stage 1A. Treatment to start next week is ABVD. Doesn't seem right? Why not rituximab?

NF-
Well ABVD is the so-called 'gold standard' in treating Hodgkin's Lymphomas, so that much would make sense if NLPHL were still considered among classic Hodgkin's Disease. It isn't, however, and the cancer does express on CD20, which rituximab targets.

However, it's possible that rituximab has only been approved for treating non-hodgkin's (see this page at ACS) and his doctors are being conservative. There are also issues regarding side effects, such as those affecting the kidneys, perhaps your son has outstanding health issues that make a monoclonal antibody like this dangerous?

I would also ask about what kinds of clinical studies have been done with the drug on people as young as your son. It's possible no one knows for sure how someone his age may react.

Finally, rituximab has been getting some dubious press lately regarding a fatal brain virus. The link is tenuous, and far too early to know for certain anything, but again perhaps his docs are being conservative.

Either way, as you probably know the good news is that NLPHL has a very high cure rate - a word I use with caution - of around 90%, and in stage 1A even better.

Please check back and let us know their response.

Ross

I was just diagnosed with NLPHL this week. My VA doctors e prescribed R-CHOP for 3-4 months. It seems like there is a very cloudy line as to whether NLPHL is Hodgkins or Non-hodgkins. My blog is havhttp://fightinglymphoma.blogspot.com/ My oncologist gave me the choice of 1) taking just rituxin and "coexisting with the enemy" or 2) R-CHOP and going for "Complete Response"

I'm going for the R-CHOP

They recommended rituxan and radiation for a subtype of Hodgkin's lymphoma? And the second opinion recommended R-CHOP?

I've never seen that before.

I stand corrected. For many years now, NLPHL patients have been treated under the same guidelines as patients with Classical HL, but that is changing, as more is learned about how different NLPHL is, notably in its more indolent course.

As for standard treatment guidelines for NLPHL, there are at least published recommendations, which you can find at the National Comprehensive Cancer Network's web site (nccn.org), they have recommendations for NLPHL in their Hodgkin's treatment guidelines, and they do include R-CHOP.