Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is characterized by the expression of B-cell associated antigen CD20. Due to this characteristic it has been proposed the use of the anti-CD20 antibody but at now, there is no consensus on which chemotherapy regimen should be used. In patients with stage IA two prospective studies evaluated the role of the anti-CD20 antibody in monotherapy (GHSG and Stanford); both of them concluded that rituximab cannot be recommended as a first-line therapy and ESMO guidelines recommend radiotherapy for this subset of patients. In other stages chemotherapy is generally recommended, but there is no consensus on whether classical HL-directed regimens, such as ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), or B-cell lymphoma-directed regimens, such as R-CHOP (rituximab, cychlophosphamide, doxorubicin, vincristine, prednisone) should be used. In order to plan clinical trials and to test our potential accrual we performed a retrospective analysis of patients treated between 2000 and 2016 in 8 Italian hematologic centers. We identified 113 pts affected by NLPHL (41 stage I without symptoms, 40 stage II, 21 stage III, 11 stage IV). 11 patients had extranodal disease (pancreas, intestine, skin, lung, liver, bone marrow, muscle), 14 had spleen involvement and 9 had B symptoms. Median age at diagnosis was 43, male:female ratio was 2.9. Median follow-up is 62 months (range 1-199 months). 5yr-OS and 3yr-EFS were respectively 95.5% and 85.9%.13 patients had relapse of NLPHL, 5 patients had transformation to DLBCL at a median of 14 months, 4 patients died (1 from acute myelogenous leukemia, 1 from progression of disease, 1 from stomach cancer and 1 for interstitial pneumonia during ABVD). Treatments for non-stage I pts were as follows: 29 ABVD ± IFRT (II 19, III 6, IV 4), 13 R-ABVD (II 5, III 5, IV 3), 24 R-CHOP ± IFRT (II 10, III 10, IV 4) and 6 other (2 observation, 2 IFRT, 1 Rituximab, 1 CHOP like).3-years event-free survival are as follows: 78.5% (58-90) for ABVD±RT, 100% for R-ABVD and 74% for R-CHOP (48-88). No statistically significant difference was observed in terms of EFS neither for therapy regimen (p 0.512) , nor for stage and spleen involvement (p 0.33). Our data do not show any difference among classical HL-directed regimens, B-cell lymphoma-directed regimens or composite approach. A prospective randomized large cohort evaluation should be taken into account