Initial treatment of aggressive lymphomas

Many patients can be cured by combination chemotherapy or by radiotherapy.

Localised DLBCL: patients with stage I and non-bulky stage II (mass <10 cm) disease without adverse prognostic factors treated with 3 cycles of CHOP followed by involved field radiotherapy (45-50Gy) achieve a 99% response rate 77% PFS and 85% long term survival. This is superior to radiotherapy alone (15% relapse in irradiation field) and to 8 cycles of CHOP.

Advanced stage DLBCL: several chemotherapy regimens have curative potential. CR rates 50% to >80%. Although CR rates to CHOP regimen have been bettered by some multi-agent regimens, long-term follow-up reveals comparable or inferior long-term PFS rates and greater treatment related toxicity. A prospective randomised trial comparing CHOP, m-BACOD, ProMACE-CytaBOM, and MACOP-B revealed no significant difference in response rates, time to treatment failure or survival. Several trials failed to demonstrate the superiority of any particular chemotherapy regimen for NHL. The CHOP regimen (p604) has been widely used because of ease of administration and relative tolerability. Some 30% of patients are cured using CHOP alone. The addition of Rituximab to CHOP improves responses and survival (see below).2 R-CHOP has been endorsed by NICE5 for use as first line therapy in CD20+ DLBCL stage II, III or IV. Evaluate response to therapy after 3-4 courses and complete 6 courses if complete remission has been achieved.

Consolidation therapy in DLBCL: in future different protocols may be appropriate for different risk groups of patients (risk-adapted therapy). Consolidation of 1st CR by high dose therapy and autologous SCT has

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