Treatment for Indolent, Noncontiguous Stage II / III / IV Adult NHL
Optimal treatment of advanced stages of low-grade non-Hodgkin lymphoma is controversial because of low cure rates with the current therapeutic options. Numerous clinical trials are in progress to settle treatment issues, and patients should be urged to participate. The rate of relapse is fairly constant over time, even in patients who have achieved complete response to treatment. Indeed, relapse may occur many years after treatment. Currently, no randomized trials guide clinicians about the initial choice of watchful waiting, rituximab, nucleoside analogs, alkylating agents, combination chemotherapy, radiolabeled monoclonal antibodies, or combinations of these options.; [Level of evidence: 1iiDiii]For patients with indolent, noncontiguous stage II and stage III non-Hodgkin lymphoma, central lymphatic radiation therapy has been proposed but is not usually recommended as a form of treatment.[3,4]Numerous prospective clinical trials of interferon-alpha,
High-Stage Childhood Anaplastic Large Cell Lymphoma Treatment
Children and adolescents with high-stage (stage III or IV) anaplastic large cell lymphoma have a disease-free survival of approximately 60% to 75%.[1,2,3,4,5,6] It is unclear which strategy is best for the treatment of high-stage anaplastic large cell lymphoma. The German Berlin-Frankfurt-Munster (BFM) group used six cycles of intensive pulsed therapy, similar to their B-cell non-Hodgkin lymphoma (NHL) therapy (GER-GPOH-NHL-BFM-90 [NHL-BFM-90]).; [Level of evidence: 1iiA] Building on these results, the European Intergroup for Childhood NHL (EICNHL) group conducted the FRE-IGR-ALCL99 study (based on the GER-GPOH-NHL-BFM-90 regimen). First, this randomized study demonstrated that methotrexate 1 g/m2 infused over 24 hours plus intrathecal methotrexate and methotrexate 3 g/m2 infused over 3 hours without intrathecal methotrexate yielded similar outcomes.[Level of evidence: 1iiC] However, methotrexate 3 g/m2 over 3 hours had less toxicity than methotrexate 1 g/m2 over 24
Recurrent Adult Non-Hodgkin Lymphoma
Recurrent adult non-Hodgkin lymphoma is cancer that has recurred (come back) after it has been treated.
Changes to This Summary (02 / 19 / 2013)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above. General Information About Adult Non-Hodgkin Lymphoma (NHL)Updated statistics with estimated new cases and deaths for 2013 (cited American Cancer Society as reference 2).Indolent NHLAdded text to state that follicular lymphoma in situ and primary follicular lymphoma of the duodenum are particularly indolent variants that rarely progress and rarely require therapy (cited Schmatz et al. and Jegalian et al. as references 17 and 18, respectively).Revised text to state that myeloablative therapy with autologous or allogeneic hematopoietic stem cell support is under clinical evaluation (cited Kyriakou et al. as reference 48).Added Nakamura et al. as reference 62.Added Kempf et al. as reference 97.Aggressive NHLAdded Glantz et al. as reference 18.Added text to state that similar response rates in
Stages of Childhood Non-Hodgkin Lymphoma
Stages of childhood non-Hodgkin lymphoma
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Sources of further information about Childhood Non-Hodgkin Lymphoma Treatment.
Treatment for Indolent, Stage I and Contiguous Stage II Adult NHL
Although localized presentations are uncommon in non-Hodgkin lymphoma (NHL), the goal of treatment should be to cure the disease in patients who are shown to have truly localized occurrence after undergoing appropriate staging procedures.Standard Treatment Options for Indolent, Stage I and Contiguous Stage II Adult NHLStandard treatment options for indolent, stage I and contiguous stage II adult NHL include the following:Radiation therapy.Rituximab with or without chemotherapy.Watchful waiting.Other therapies as designated for patients with advanced-stage disease.Radiation therapy Long-term disease control within radiation fields can be achieved in a significant number of patients with indolent stage I or stage II NHL by using dosages of radiation that usually range from 25 Gy to 40 Gy to involved sites or to extended fields that cover adjacent nodal sites.[1,2,3,4] Almost half of all patients treated with radiation therapy alone will relapse out-of-field within 10 years.Rituximab
Stage Information for Adult NHL
Stage is important in selecting a treatment for patients with non-Hodgkin lymphoma (NHL). Chest and abdominal computed tomographic (CT) scans are usually part of the staging evaluation for all lymphoma patients. The staging system is similar to the staging system used for Hodgkin lymphoma.Common among patients with NHL is involvement of the following:Noncontiguous lymph nodes.Waldeyer ring.Epitrochlear nodes.Gastrointestinal tract.Extranodal presentations. (A single extranodal site is occasionally the only site of involvement in patients with diffuse lymphoma.)Bone marrow.Liver (especially common in patients with low-grade lymphomas).Cytologic examination of cerebrospinal fluid may be positive in patients with aggressive NHL. Involvement of hilar and mediastinal lymph nodes is less common than in Hodgkin lymphoma. Mediastinal adenopathy, however, is a prominent feature of lymphoblastic lymphoma and primary mediastinal B-cell lymphoma, entities primarily found in young
Changes to This Summary (04 / 04 / 2013)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.Cellular Classification of Childhood NHLAdded Godot et al. as reference 42 and Louissaint et al. as reference 48.Revised text to state that mucosa-associated lymphoid tissue (MALT) lymphomas observed in pediatric patients usually present as low-stage disease, and pediatric gastric MALT lymphomas are associated with Helicobacter pylori and require no more than local therapy involving curative surgery and/or radiation therapy. Also added text to state that conjunctival MALT lymphomas are often associated with chlamydial psittaci infections (cited Stefanovic et al. as reference 54).Added text to state that an oral retinoid (bexarotene) has been reported to be active against subcutaneous panniculitis-like T-cell lymphomas and cutaneous gamma-delta T-cell lymphomas in a series of 15 patients from
Stages of Adult Non-Hodgkin Lymphoma
After adult non-Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.