Childhood nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare, indolent lymphoma lacking an evidence-based standard of care worldwide. In Brazil, where resources can be scarce, non-specific therapeutic protocols developed for other lymphoma subtypes are often used, but there are no data to understand current practices and patient outcomes. A retrospective analysis of data from patients treated for NLPHL at Brazilian centers is necessary to assess these fundamental baseline data. This multicenter retrospective study aims to analyze the clinical, histopathological, and therapeutic profile of pediatric NLPHL cases in Brazil. Secondary objectives include characterizing immunohistochemistry findings and evaluating clinical outcomes.
In partnership with Global nLPHL One Working Group (GLOW) and the Consorcio Latinoamericano de Enfermedades Hemato-oncologicas Pediatricas (CLEHOP) members, 27 Brazilian institutions were invited to participate in a retrospective study of NLPHL. Patients aged <19 years diagnosed with NLPHL between January 2023 and June 2025 were included. Data were extracted from physical and electronic medical records using standardized electronic spreadsheets. Statistical analysis was descriptive.
Preliminary analysis includes 15 patients from 7 institutions. The cohort has male predominance (80%). Most patients were diagnosed at early stages: 47% at stage I, 47% at stage II, and 6% at stage IV. Immunohistochemistry showed CD20 positivity in 100% of cases and CD30 positivity in 27% of cases. Management strategies included observation after surgical resection in 27% (4/15), chemotherapy + radiotherapy in 6% (1/15) and chemotherapy alone in 67% (10/15),with primarily CVP-based regimens. Rituximab was added in 90% of these chemotherapy regimens (10/11). With a median follow-up of 22.6 months, 80% achieved a complete response, while 3 patients (20%) experienced disease recurrence, with one death after disease progression. Notably, 2 of the 3 patients who relapsed had been managed with observation alone, and all of them were rescued with chemotherapy afterward.
Preliminary results from this Brazilian registry indicate that although pediatric NLPHL appears to have an excellent overall outcome, disease recurrence remains a significant issue even in early-stage patients. This systematic collection of this multicenter data is essential for building evidence to understand how to support strategies for this rare cancer .
Adriana Morais, Juliana Costa, Ana Rosa Costa, Monica Palese, Michael Binkley, Jamie Flerlage