NCCN Guidelines for Patients® | Mantle Cell Lymphoma

42 NCCN Guidelines for Patients ® : Mantle Cell Lymphoma, 2017 Extensive stage II and stages III‒IV Guide 7 lists options for extensive stage II and stages III and IV. These lymphomas involve a large area either above or below the diaphragm, are on both sides of the diaphragm, or have widely spread outside the lymphatic system. Without blood stem cell transplant You may be unable to receive a stem cell transplant. In this case, a clinical trial is an option. Another option is immunochemotherapy that is not too harsh on the body. Immunochemotherapy Options are listed in Guide 7. They 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 should receive these drugs. These regimens are further explained on page 39. 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 CT or PET/CT will be used to assess the results of immunochemotherapy. If there are no signs of the cancer, you may join a clinical trial. Another option may be rituximab. It is received every 8 to 12 weeks for 2 years or sometimes longer. There may be less cancer after treatment. In this case, a second-line treatment may be received. The goal is to fully treat the cancer so there are no cancer signs with imaging. The cancer may be the same or worse after immunochemotherapy. In this case, read Guide 9 for options. With blood stem cell transplant You may be able to receive a stem cell transplant. In this case, a clinical trial is an option. Another option is immunochemotherapy followed by an autologous blood stem cell transplant. This option is for people who are typically younger than age 70 and who have good health other than cancer. Immunotherapy regimens are further explained on page 39 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 CT or PET/CT will be used to assess the results of immunochemotherapy. If the cancer can’t be seen, you may join a clinical trial or have an autologous stem cell transplant. After the transplant, you may re- start rituximab. It is received every 8 to 12 weeks for 2 years or sometimes longer. There may be less cancer after treatment. In this case, a second-line treatment may be received. The goal is to fully treat the cancer so a stem cell transplant is an option. The lymphoma may be the same or worse after immunochemotherapy. In this case, read Guide 9 for options. 4 Treatment guide Extensive stage II and stages III‒IV

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