Adult Non-Hodgkin Lymphoma Treatment (PDQ®): Treatment - Health Professional Information [NCI]-Treat
Adult Non-Hodgkin Lymphoma Treatment (PDQ®): Treatment - Health Professional Information [NCI]-Treatment for Aggressive, Noncontiguous Stage II / III / IV Adult NHL
The treatment of choice for patients with advanced stages of aggressive non-Hodgkin lymphoma (NHL) is combination chemotherapy, either alone or supplemented by local-field radiation therapy.[1]
The following drug combinations are referred to in this section:
Understanding Leukemia -- Symptoms
Many types of leukemia produce no obvious symptoms in the early stages. Eventually, symptoms may include any of the following: Anemia and related symptoms, such as fatigue, pallor, and a general feeling of illness. A tendency to bruise or bleed easily, including bleeding from the gums or nose, or blood in the stool or urine. Susceptibility to infections such as sore throat or bronchial pneumonia, which may be accompanied by headache, low-grade fever, mouth sores, or skin rash....
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Standard Treatment Options for Aggressive, Noncontiguous Stage II/III/IV Adult NHL
Standard treatment options for Aggressive, Noncontiguous Stage II/III/IV Adult NHL include the following:
R-CHOP
The following studies established R-CHOP as the standard regimen for newly diagnosed patients with DLBCL.[2] Dose intensification of R-CHOP by a 14-day versus a 21-day cycle did not result in improved outcomes.[3]
Evidence (R-CHOP):
The following drug combinations are referred to in this section:
Recommended Related to Leukemia & Lymphoma
Understanding Leukemia -- Symptoms
Many types of leukemia produce no obvious symptoms in the early stages. Eventually, symptoms may include any of the following: Anemia and related symptoms, such as fatigue, pallor, and a general feeling of illness. A tendency to bruise or bleed easily, including bleeding from the gums or nose, or blood in the stool or urine. Susceptibility to infections such as sore throat or bronchial pneumonia, which may be accompanied by headache, low-grade fever, mouth sores, or skin rash....
Read the Understanding Leukemia -- Symptoms article > >
- ACVBP: doxorubicin + cyclophosphamide + vindesine + bleomycin + prednisone.
- CHOP: cyclophosphamide + doxorubicin + vincristine + prednisone.
- CNOP: cyclophosphamide + mitoxantrone + vincristine + prednisone.
- m-BACOD: methotrexate + bleomycin + doxorubicin + cyclophosphamide + vincristine + dexamethasone + leucovorin.
- MACOP-B: methotrexate + doxorubicin + cyclophosphamide + vincristine + prednisone fixed dose + bleomycin + leucovorin.
- ProMACE CytaBOM: prednisone + doxorubicin + cyclophosphamide + etoposide + cytarabine + bleomycin + vincristine + methotrexate + leucovorin.
- R-CHOP: rituximab, an anti-CD20 monoclonal antibody, + cyclophosphamide + doxorubicin + vincristine + prednisone.
Standard Treatment Options for Aggressive, Noncontiguous Stage II/III/IV Adult NHL
Standard treatment options for Aggressive, Noncontiguous Stage II/III/IV Adult NHL include the following:
- R-CHOP.
- Other combination chemotherapy.
R-CHOP
The following studies established R-CHOP as the standard regimen for newly diagnosed patients with DLBCL.[2] Dose intensification of R-CHOP by a 14-day versus a 21-day cycle did not result in improved outcomes.[3]
Evidence (R-CHOP):
- R-CHOP showed improvement in event-free survival (EFS) and overall survival (OS) compared with CHOP alone in 399 advanced-stage patients with DLBCL older than 60 years (EFS, 57% vs. 38%; P = .002, and OS, 70% vs. 57%; P = .007 at 2 years).[4][Level of evidence: 1iiA] At 10-years' median follow-up, the OS of patients who received R-CHOP compared with patients who received CHOP was 44% versus 28%, P < .0001.[5]
- Similarly, for 326 evaluable patients younger than 61 years, R-CHOP showed improvement in EFS and OS compared with CHOP alone (EFS, 79% vs. 59%, P = .001, and OS, 93% vs. 84%, P = .001 at 3 years).[6][Level of evidence: 1iiA]
- A randomized study (DSHNHL-1999-1A [NCT00052936]) of 1,222 patients older than 60 years compared R-CHOP given every 2 weeks for six or eight cycles to CHOP given every 2 weeks for six or eight cycles.[7] With a median follow-up of 72 months, the EFS favored R-CHOP given every 2 weeks for six or eight cycles (EFS at 6 years, 74% vs. 56%; P < .0001). The OS favored R-CHOP for only six cycles because of increased toxicity in the eight-cycle arm (OS at 6 years, 90% vs. 80%; P = .0004).[7][Level of evidence: 1iiA] There was no comparison to standard R-CHOP or CHOP given every 3 weeks.