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Non-Hodgkin's Lymphoma

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Treatment for Indolent, Stage I and Contiguous Stage II Adult NHL

    Although localized presentations are uncommon in non-Hodgkin lymphoma (NHL), the goal of treatment should be to cure the disease in patients who are shown to have truly localized occurrence after undergoing appropriate staging procedures.

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

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

    1. Radiation therapy.
    2. Rituximab with or without chemotherapy.
    3. Watchful waiting.
    4. Other therapies as designated for patients with advanced-stage disease.

    Radiation therapy

    Long-term disease control within radiation fields can be achieved in a significant number of patients with indolent stage I or stage II NHL by using dosages of radiation that usually range from 25 Gy to 40 Gy to involved sites or to extended fields that cover adjacent nodal sites.[1,2,3,4] Almost half of all patients treated with radiation therapy alone will relapse out-of-field within 10 years.[5]

    Rituximab with or without chemotherapy

    For symptomatic patients who require therapy, when radiation therapy is contraindicated or when an alternative treatment is preferred, rituximab with or without chemotherapy can be employed (as outlined below for more advanced-stage patients). The value of adjuvant treatment with radiation to decrease relapse, plus rituximab (an anti-CD20 monoclonal antibody) either alone or in combination with chemotherapy, has been extrapolated from trials of patients with advanced-stage disease and has not been confirmed.[6,7]

    Watchful waiting

    Watchful waiting can be considered for asymptomatic patients.[8] Watchful waiting has never been compared with upfront radiation therapy in a prospective randomized trial; a retrospective analysis of the Surveillance, Epidemiology and End Results Program (SEER) database over 30 years showed improved outcomes for upfront radiation therapy.[9]

    Other therapies as designated for patients with advanced-stage disease

    Patients with involvement not encompassable by radiation therapy are treated as outlined for patients with stage III or stage IV low-grade lymphoma.

    Current Clinical Trials

    Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with indolent, stage I adult non-Hodgkin lymphoma and indolent, contiguous stage II adult non-Hodgkin lymphoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

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