Treating Indolent NHL
| Types of Indolent NHL lymphomas |
Treatment for patients with Stage I and some Stage II Indolent NHL may include: |
Treatment for patients with Stage III, Stage IV, and some Stage II Indolent NHL may include: |
| Follicular B-cell |
Radiation (local radiation produces excellent results, with remissions lasting at least 10 years in about half of all patients). |
A standard therapy has not been determined. Options include:
|
| Small lymphocytic lymphoma and chronic lymphocytic leukemia |
Antibiotics may sometimes be used for several indolent lymphomas.
|
Watchful waiting
OR
Chemotherapy (common treatments include chlorambucil, CHOP, fludarabine, and FND).
|
| Marginal zone lymphoma Monocytoid B-cell Mucosa-associated lymphoid tissue (MALT) lymphoma |
|
AND/OR
Biologic therapies (such as monoclonal antibodies, interferon) may be given alone or with chemotherapy. |
| Waldenstrom's macroglobulinemia |
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Treating Intermediate & High-Grade (Aggressive) NHL
| Types of Intermediate & High-Grade (Aggressive) NHL |
Treatment for patients with Stage I and some Stage II Aggressive NHL may include: |
Treatment for patients with Stage III or IV Aggressive NHL may include: |
|
Diffuse large B-cell lymphoma
|
Full dose chemotherapy.
|
Combination chemotherapy, sometimes with local radiation for bulky disease |
| Mantle cell lymphoma (MCL) |
OR Chemotherapy plus radiation |
The standard therapy is CHOP or R-CHOP*
|
| |
The standard therapy is CHOP or R-CHOP* |
Hyper CVAD (MCL) |
| |
|
Some patients at high risk may be offered high dose chemotherapy followed by bone marrow or stem cell transplantation. |
| |
*R-CHOP = CHOP plus Rituximab (Rituxan®)
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Treating Other NHLs
Cutneous T-Cell Lymphoma
CTCL (Mycosis fungoides) |
Skin directed therapies: |
| |
Corticosteroid creams and ointments
OR
Topical bexarotene (Targretin®) gel applied only to CTCL lesions.
OR
UVB and /or PUVA (ultraviolet light of B or A wavelength)
OR
|
| |
Topical Chemotherapy
Nitrogen mustard
Carmustine
Total or localized skin electronbeam radiation |
| |
Bexarotene (Targretin®)capsules
OR
Denileukin diftitox (Ontak®)
OR
Extracorporeal photopheresis (ECP)
OR
Interferon-alfa (Intron®-A, Roferon® A)
OR
Alemtuzumab (Campath®)
|
| |
Traditional Chemotherapy |
|
Methotrexate (Rheumatrex®)
OR
Fludarabine (Fludara®)
OR
Combination chemotherapy
|
| AIDS-related lymphoma |
Standard dose CHOP
OR
Low-dose m-BACOD
AND
Possibly, an infusion of chemotherapy into cerebrospinal fluid to prevent relapse in the brain
|
|
Childhood/pediatric NHL
Burkitts lymphoma
Non-Burkitt’s lymphoma
Large cell lymphoma
|
Chemotherapy is the standard therapy
AND
Possibly, an infusion of chemotherapy into the cerebrospinal
fluid to prevent or combat central nervous system disease
Bone marrow transplantation is being tested in clinical trials
|
|
Central nervous system lymphoma
Primary brain lymphoma
Lymphomatous meningitis
|
Radiation
OR
Chemotherapy
OR
A combination of radiation and chemotherapy
OR
For lymphomatous meningitis, an infusion of chemotherapy
into the cerebrospinal fluid
|
