NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

47 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 Guide 12 shares first-time treatment of Richter’s transformation and CLL with progression. A clinical trial is advised. If you can’t join a clinical trial, you will have treatment that is recommended for DLBCL and Hodgkin lymphoma, or CLL with progression. Some combinations of drugs including chemotherapy and immunotherapy are listed for DLBCL with cell features similar to CLL. If you have CLL with progression, you will refer to the guides earlier in this chapter. See the guides listed for CLL without del(17p) or TP53 mutation, or CLL with del(17p) or TP53 mutation. Ask your doctor to share what options are available for disease that progresses. Guide 12. First-time treatment options for Richter’s transformation and CLL with progression Cancer type First-time treatment options DLBCL Cell features not like CLL ª • Clinical trial or • NCCN Guidelines for B-Cell Lymphomas (treatment for DLBCL) Cell features like CLL ª • Clinical trial (preferred) or • CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) + rituximab • DA-EPOCH (etoposide, cyclophosphamide, doxorubicin, vincristine, prednisone) + rituximab • HyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone), + rituximab • OFAR ( o xaliplatin, f ludarabine, c ytarabine, r ituximab) Hodgkin lymphoma ª • Clinial trial (preferred) or • See NCCN Guidelines for Hodgkin Lymphoma CLL with progression • Without del(17p) or TP53 mutation ª • Clinical trial or • See Guides 3 to 7 • With del(17p) or TP53 mutation ª • Clinical trial or • See Guides 9 and 10 4 Treatment guide Richter’s transformation and CLL with progression

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