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Non-Hodgkin's Lymphoma

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Adult Non-Hodgkin Lymphoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment for Aggressive, Stage I and Contiguous Stage II Adult NHL

Patients with stage I or contiguous stage II diffuse large B-cell lymphoma are candidates for combination chemotherapy with or without involved-field radiation therapy (IF-XRT).

The following drug combinations are referred to in this section:

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Understanding Non-Hodgkin Lymphoma -- Symptoms

Symptoms of non-Hodgkin lymphoma may include: Painless swelling of one or more lymph nodes, with no recent infection. Swelling may be intermittent. Swelling, fluid accumulation, or pain in the abdomen. Shortness of breath, wheezing, or coughing. Bloody stool or vomit. Swelling of the face, neck, and arms. Blockage of urine flow. Bone pain. Unexplained weight loss amounting to 10% of body weight over six months. Fever lasting for at least 14 consecutive days, usually in...

Read the Understanding Non-Hodgkin Lymphoma -- Symptoms article > >

  • R-CHOP: rituximab, an anti-CD20 monoclonal antibody, + cyclophosphamide + doxorubicin + vincristine + prednisone.

Standard Treatment Options for Aggressive, Stage I and Contiguous Stage II Adult NHL

Standard treatment options for aggressive, stage I and contiguous stage II adult NHL include the following:

  1. R-CHOP with or without IF-XRT.

R-CHOP with or without IF-XRT

Four prospective randomized trials have evaluated the comparison of CHOP or more intensive CHOP-based chemotherapy alone versus combined–modality therapy with CHOP and IF-XRT.[1,2,3,4,5]

Evidence (CHOP vs. CHOP with IF-XRT):

  1. In a randomized trial with 7 years' median follow-up, 576 patients older than 60 years with early-stage disease received four cycles of CHOP with or without IF-XRT; there was no difference in 5-year event-free survival (EFS) (61% vs. 64%, P = .5) or overall survival (OS) (72% vs. 68%, P = .6).[1][Level of evidence: 1iiA]
  2. A randomized trial of 401 patients comparing eight cycles of CHOP to three cycles of CHOP with IF-XRT was initially reported as having an OS advantage for the combined–modality arm at 5 years,[2] but a re-evaluation for OS at 9 years showed no difference in either arm of the study.[3][Level of evidence: 1iiA]
  3. A randomized study (EST-1484) of 210 patients who attained a radiologic complete remission after eight cycles of CHOP compared IF-XRT with no further therapy; there was no difference in OS at 10 years (68% vs. 65%, P = .24).[4][Level of evidence: 1iiA]
  4. A randomized trial of 631 patients younger than 60 years compared more intensive CHOP-based chemotherapy versus three cycles of CHOP with IF-XRT; with 4 years' median follow-up, the intensive chemotherapy was superior in 5-year EFS (82% vs. 74%, P > .001) and 5-year OS (90% vs. 81%, P = .001).[5][Level of evidence: 1iiA]

The confirmation of efficacy for rituximab in advanced-stage disease as evidenced in SWOG-S0014 (NCT00005089), for example, has suggested the use of R-CHOP with or without radiation therapy but its use is only supported by retrospective comparisons.[6][Level of evidence: 3iiiDiii]

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