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

44 NCCN Guidelines for Patients ® : Diffuse Large B-cell Lymphoma, 2017 Second-line treatment Guide 8 lists options for second-line treatment. These options are used if first-treatment didn’t work. They are also used if the lymphoma reappears on tests. Your treatment options are based on whether you plan to have a blood stem cell transplant. Transplant planned Chemotherapy is first received. Rituximab may be added. There is no preferred regimen among those listed in the Guide. For CNS disease, other drugs will be added to the regimen you will receive. Most CNS disease can be treated with methotrexate. Sometimes rituximab or cytosine arabinoside are also used. The two innermost layers of your brain’s membrane are called the leptomeninges. If the cancer has spread to this site, treatment includes both methotrexate and cytarabine. After chemotherapy, treatment results will be assessed. Imaging tests are used. PET/CT has been found to be very useful. Imaging should occur at least 8 weeks after treatment. Results are used to advise the next steps in treatment. If the cancer appears to be gone or smaller, there are 3 treatment options. The first option is consolidation treatment with an autologous blood stem cell transplant. The goal of consolidation treatment is to kill any cancer cells that may remain. The second and third options are clinical trials and, for some people, an allogeneic blood stem cell transplant. Ask your doctor if you can have an allogeneic transplant. Radiation therapy may improve the results of a transplant. Involved-site radiation therapy before the transplant may be received. In addition, sites that had cancer may be treated with more radiation before or after the transplant. If the cancer looks the same or larger, there are four options. The first option is to join a clinical trial. The second option is treatment with one of the regimens listed in Guide 8 Blood stem cell transplant is not planned . The third option is radiation therapy to cancer sites to relieve symptoms. Relief of symptoms is part of supportive care. The fourth option is supportive care other than radiation therapy. Transplant not planned Join a clinical trial if you can. If you can’t, the drug regimens that are listed in the Guide are advised. For CNS disease, other drugs such as methotrexate will be added to the regimen you accept. A third option is radiation therapy to cancer sites to relieve symptoms. Relief of symptoms is part of supportive care. The fourth option is supportive care other than radiation therapy. Review † † Options for initial treatment of DLBCL are based on the stage of the cancer. † † Stage I and II cancers are often treated with 6 cycles of immunochemotherapy followed by radiation therapy. Small cancers may be fully treated with only 3 cycles. Another option is treating the cancer with only chemotherapy and rituximab. † † Stage III and IV cancers are often treated with 6 cycles of immunochemotherapy. A second option is to join a clinical trial. If 6 cycles of treatment works, you may be further treated with radiation therapy, lenalidomide, or a blood stem cell transplant. † † Second-line treatment is based on whether a blood stem cell transplant is planned. 4 Treatment guide Second-line treatment | Review

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