NCCN Guidelines for Patients® | Diffuse Large B-cell Lymphoma

38 NCCN Guidelines for Patients ® : Diffuse Large B-cell Lymphoma, 2017 Part 4 is a guide to the treatment options for DLBCL. It starts with explaining the first treatments received by cancer stage. If treatment works, the health care for after treatment is listed. The last section lists options for second-line treatment. Your doctor may suggest other options based on your health and wishes. Fully discuss your options with your doctor. First-line treatment Treatment options are partly based on cancer stage. Treatment for stages I and II are discussed next. Treatment for stages III and IV are discussed starting on page 42. Stages I & II Guide 4 lists options for initial treatment of stages I and II. These lymphomas are either above or below the diaphragm. The lymphoma may be in more than one cluster of lymph nodes. If so, it is confined to a small area. Treatment options are based on the size of the lymphoma. Large (bulky) lymphomas are 7.5 cm or larger. Small (non-bulky) lymphomas are smaller than 7.5 cm. Options 1 and 2 are for lymphomas of any size. Option 3 is for small lymphomas. Option 1 The lymphoma will be treated with rituximab-based chemotherapy then by radiation. Chemotherapy will be given for 6 cycles. If you are unable to receive chemotherapy, involved-site radiation therapy alone may be received. Some chemotherapy may harm your health. Thus, your current health and age will affect which chemotherapy you will receive. Start treatment with RCHOP if you are healthy. If you have heart problems or are frail, your options include RCEPP, RCDOP, DA-EPOCH with rituximab, RCEOP, and RGCVP. RGCVP and R-mini-CHOP can be received if you are older than 80 years of age and have multiple health conditions. When chemotherapy is finished, treatment results will be checked. Imaging tests are used. PET/CT has been found to be very useful for checking results. Imaging should occur at least 8 weeks after treatment. Results are used to advise the next steps in treatment. If there are no signs of cancer, there is no need to change your treatment plan. Radiation therapy may be received. If the cancer looks smaller, a biopsy may be done to confirm there’s cancer. If no cancer is found, radiation therapy may be received. If cancer is found or a biopsy isn’t done, you have three options. These options are high-dose radiation therapy, a blood stem cell transplant with or without radiation therapy, and joining a clinical trial. Imaging tests may suggest that the cancer is the same or larger. In this case, read Guide 8 for treatment options. Radiation therapy may also be an option if you can’t receive chemotherapy. Option 2 Option 2 includes treating the cancer with only chemotherapy and rituximab. No radiation will be used. Chemotherapy will be given for 6 cycles. Some chemotherapy may harm your health. Thus, your current health and age will affect which chemotherapy you will receive. Start treatment with RCHOP if you are healthy. If you have heart problems or are frail, your options include RCEPP, RCDOP, DA-EPOCH with rituximab, RCEOP, and RGCVP. RGCVP and R-mini-CHOP can be received 4 Treatment guide First-line treatment

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