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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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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]

  • R-CHOP (rituximab + cyclophosphamide + doxorubicin + vincristine + prednisone); four to six cycles.
  • R-CHOP (three to six cycles) + IF-XRT.

Evidence (R-CHOP vs. CHOP):

  • A randomized study (DSHNHL-1999-1A) of 1,222 patients older than 60 years compared R-CHOP given every 2 weeks for six or eight cycles to CHOP given every 2 weeks for six or eight cycles.[7] Although patients with early stage disease were included in this trial, most patients had advanced stage disease.
    • With a median follow-up of 72 months, the EFS favored R-CHOP given every 2 weeks for six or eight cycles (EFS at 6 y, 74% vs. 56%; P < .001).
    • The OS favored R-CHOP for only six cycles because of increased toxicity in the eight-cycle arm (OS at 6 y, 90% vs. 80%, P = .0004.[8][Level of evidence: 1iiA]
    • There has been no comparison to standard R-CHOP or CHOP given every 3 weeks. There are no comparative studies to establish an optimal number of chemotherapy cycles for patients with early stage disease.
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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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