NCCN Guidelines for Patients® | Mantle Cell Lymphoma

38 NCCN Guidelines for Patients ® : Mantle Cell Lymphoma, 2017 Stage I and limited stage II Guide 4 lists treatment options for stage I and limited stage II cancers. These cancers are rare. They are either above or below the diaphragm. If the cancer is in more than one cluster of lymph nodes, it is confined to a small area. More research is needed to learn what treatments are best. First-line treatment Two options are advised by NCCN experts. The first option is immunochemotherapy. Radiation therapy may follow. The second option is radiation therapy alone. Radiation therapy appears to be a good treatment for limited mantle cell lymphomas. For first-line treatment, immunochemotherapy options are divided into two groups. Less toxic treatments include drugs that are less likely to harm your body than other drugs. Less toxic treatments are for people who are: 1) 70 years of age and older; and 2) younger than 70 years but who have serious health problems in addition to cancer. Some doctors use a younger age to decide who can have more or fewer toxic drugs. More toxic treatments include drugs that can cause severe side effects. However, the lymphoma doesn’t come back for some time. These drugs are for people younger than age 70, who have good health other than cancer. Supportive care During and after cancer treatment, you may be treated to prevent or control other health conditions. Such actions are a part of supportive care. Health conditions that are a concern for some people include TLS, reactivated viruses, and other infections. Talk to your doctor about which health conditions you may develop as a result of cancer treatment. Treatment response At the end of treatment, you will receive an imaging test to check the results. Imaging may be done with CT or PET/CT. If there are no signs of cancer, you may start follow-up care. If there are signs of cancer, read Guide 6 for options. Guide 4. First-line treatment What are the options? • Immunochemotherapy ± radiation therapy Less toxic treatments ◦◦ Bendamustine + rituximab ◦◦ VR-CAP ◦◦ Cladribine + rituximab ◦◦ RCHOP ◦◦ Lenalidomide + rituximab ◦◦ Modified R-Hyper-CVAD More toxic treatments ◦◦ CALGB 59909 ◦◦ R-Hyper-CVAD ◦◦ NORDIC ◦◦ RCHOP/RDHAP ◦◦ RDHAP ◦◦ RCHOP/RICE • Radiation therapy alone 4 Treatment guide Stage I and limited stage II