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

40 NCCN Guidelines for Patients ® : Diffuse Large B-cell Lymphoma, 2017 4 Treatment guide First-line treatment Guide 4 continued Option 3 for small cancers Immunochemotherapy Results Treatment 3 cycles of: • RCHOP or • RCEPP • RCDOP • DA-EPOCH + rituximab • RCEOP • RGCVP • R-mini-CHOP No signs of cancer • Radiation therapy Cancer looks smaller on scans and no cancer is found with biopsy • Radiation therapy Cancer looks smaller on scans; Cancer is found with biopsy or biopsy is not done • Higher-dose radiation therapy • Clinical trial Cancer looks the same or larger • Second-line treatment ( Guide 8 ) • Radiation therapy in some cases. there’s cancer. If no cancer is found, complete the 6 cycles of chemotherapy. If cancer is found or a biopsy isn’t done, read Guide 8 for treatment options. Radiation therapy may be an option if you can’t receive chemotherapy. Option 3 Option 3 maps a third treatment option for small stage I and II cancers. It includes treating the cancer with rituximab-based chemotherapy then by radiation. Chemotherapy will be given for 3 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 if you are older than 80 years of age and have multiple health conditions. When chemotherapy is finished, treatment results will be assessed. 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. Test 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 two options. These options are high-dose 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.

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