Nodular lymphocytic predominance Hodgkin lymphoma (NLPHL) is a very uncommon subtype of Hodgkin lymphoma (HL), representing approximately 5% of all HL cases, with an incidence of 0.3/100,000 cases per year and with unique characteristics which distinguish it from classic Hodgkin lymphoma. Given its low frequency, there is a lack of prospective randomized studies to inform practice, the accumulated experience of academic groups being the main source of relevant information for the management of these patients. Eighty‐five patients recruited by the Spanish Lymphoma Group (GOTEL) from 12 different hospitals were retrospectively analyzed to describe their sociodemographic and clinical characteristics. The median follow‐up was 16 years, with a 10‐year overall survive of 92.9% and 81.2% at 20 years. Five patients developed a second malignancy. No transformation to a more aggressive lymphoma was detected. A total of 31% tumor relapses was found: 77% in a single location; most of them at a supra‐diaphragmatic level. Patients received different first‐line treatments, and progression was observed in 3/4 (75%) of the patients who did not receive any type of treatment, 6/23 (26%) who received both chemotherapy (CH) and radiotherapy (RT), 12/43 (27%) who received RT and 7/15 (47%) that received only CH treatment. The mean time to relapse was 3 years and 47% presented relapses beyond 5 years (higher probability in stage IV p < 0.001). This is one of the longest follow‐up series of NLPHL published, confirming its excellent prognosis, and that treatments may be adapted to reduce toxicity. Causes of death in these patients are varied, and the minority due to a primary malignancy relapses.

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84.6%) patients completed six cycles of therapy, 142 (66.6%) underwent interim PET2, of which 30.4% were positive, however few (n¼ 25, 17.6%) had PET-adapted modifications. A majority (89.1%) of patients received at least one supportive care product. AEs were more prevalent among older patients (>60 years). All grade neutropenia occurred in 47.1% of the patients receiving ABVD; the rate of febrile neutropenia was 6.8%. Other AEs included: infections (22.2%), anemia (27.6%), thrombocytopenia (2.7%). Cardiovascular or pulmonary complications occurred in 5 (2.3%) and 22 (10%) ABVD patients, respectively, 11 of whom had undergone PET2 assessment -3 with treatment de-escalation.Conclusions: Unmet needs exist with respect to the balance between therapeutic efficacy and safety risks of 1L chemotherapies in cHL. Even when PET2 scans are available to monitor tumour response, they are not always used to modify treatment management. Most patients continue to rely on supportive care products, or experience avoidable toxicities, underscoring the importance of new treatment combinations with novel agents.

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