sinuses, testicles, or near the spinal cord, it may spread to the central nervous system. Therefore, chemotherapy may be given into the spinal fluid.
The doctor must consider the possibility that chemotherapy might quickly destroy the lymphoma. This can flood the body with break-
down products of the dead lymphoma cells, These breakdown products can interfere with heart and kidney function. Drugs such as allopurinol or rasburicase and large amounts of intravenous fluids containing sodium bicarbonate can prevent this problem.
See next page for continued treatment
See page 58 for continued treatment CHOP chemotherapy for 6–8 cycles, with or
without rituximab, with or without medium- dose radiation therapy to lymph node area
CHOP chemotherapy for 3–4 cycles, with or without rituximab, plus medium-dose radiation therapy to lymph node area
CHOP chemotherapy for 6–8 cycles, with or without rituximab, plus medium-dose radiation therapy to lymph node area
CHOP chemotherapy for 6–8 cycles plus rituximab
Clinical trial (may include high-dose treatment and stem cell transplantation) OR
CHOP chemotherapy for 6–8 cycles plus rituximab for patients over 60 (optional for younger patients)
©2005 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes without the expressed written permission of the ACS. Single copies of each page may be reproduced for personal and non-commercial uses by the reader.
After about 3 to 4 courses of chemotherapy, the doctor may repeat the imaging tests that showed the lymphoma. This will show if the lymphoma is responding to treatment.
For stages I and II lymphoma, if these tests show that the lymphoma has disappeared (sometimes scar tissue is left behind, which can be seen with a PET or gallium scan or repeat
Treatment Guidelines for Patients
Response
Further Treatment
Lymphoma has completely disappeared
Lymphoma has shrunk by more than half but not disappeared Lymphoma has not shrunk or is growing Complete planned treatment New treatment (see page 60) Complete treatment with high doses of radiation therapy OR
Consider a clinical trial or stem cell transplant Stage I & II
Repeat all positive tests
biopsy), the CHOP chemotherapy should be continued as planned along with any planned radiation. If the lymphoma has shrunk by more than half but hasn’t disappeared, more intensive radiation may be given or high-dose
chemotherapy and a stem cell transplant might be considered. If the lymphoma hasn’t shrunk by at least half, then high-dose chemotherapy and a stem cell transplant might be considered for these patients.
Diffuse Large B-Cell Lymphoma (continued)
©2005 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes without the expressed written permission of the ACS. Single copies of each page may be reproduced for personal and non-commercial uses by the reader.
Response
Follow-Up
Lymphoma has completely disappeared If lymphoma comes back Lymphoma has shrunk by more than half but not disappearedLymphoma has not shrunk or is growing
New treatment (see page 60) Doctor visits every 3 months for 2 years, then every 6 months for 3 years
After treatment is complete, repeat all positive tests
For stages III and IV lymphoma, if these tests show that the lymphoma has disappeared, the CHOP chemotherapy should be continued
as planned. If the lymphoma has shrunk by more than half but hasn’t disappeared, either the CHOP chemotherapy may be continued,
Treatment Guidelines for Patients
Response
Further Treatment
Lymphoma has completely disappeared
Lymphoma has shrunk by more than half but not disappeared Lymphoma has not shrunk or is growing Continue CHOP to a total of 6–8 cycles New treatment (see page 60) Continue CHOP to a total of 6–8 cycles OR
Consider a clinical trial Stage III,IV
Repeat all positive tests
or a clinical trial of different treatment may be recommended. If the lymphoma hasn’t shrunk by at least half, then new treatment such as
high-dose chemotherapy and a stem cell transplant may be recommended to eligible patients.
Diffuse Large B-Cell Lymphoma (continued)
©2005 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes without the expressed written permission of the ACS. Single copies of each page may be reproduced for personal and non-commercial uses by the reader.
Response
Follow-Up
Lymphoma has completely disappeared If lymphoma comes back Lymphoma has shrunk by more than half but not disappearedLymphoma has not shrunk or is growing
New treatment (see page 60) Doctor visits every 3 months for 2 years, then every 6 months for 3 years
After treatment is complete, repeat all positive tests
If the patient is a candidate for high-dose chemotherapy, he or she should first be given a new chemotherapy regimen such as ICE, DHAP, or MIME. Rituximab may also be given.
If the lymphoma responds by shrinking by more than half, then the transplant can take place. If it doesn’t shrink that much, then a transplant isn’t considered appropriate.