What are the NCCN guidelines on first-line therapy in the treatment of NHL/B-cell follicular lymphoma?

Updated: Feb 23, 2021
  • Author: Mohammad Muhsin Chisti, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The NCCN guidelines recommend the following regimens as preferred first-line therapy (in alphabetical order) [27] :

  • Bendamustine + obinutuzumab or rituximab
  • CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) + obinutuzumab or rituximab
  • CVP (cyclophosphamide, vincristine, prednisone) + obinutuzumab or rituximab
  • Lenalidomide + rituximab

Rituximab (375 mg/m2 weekly for 4 doses) may be considered for patients with a low tumor burden. Lenalidomide + obinutuzumab (category 2B recommendation)

For elderly or infirm patients who, in the opinion of treating physician, are unlikely to tolerate most of the above regimens, suggested options for first-line, second-line, and subsequent therapy include the following:

  • Rituximab (preferred) (375 mg/m 2 weekly for 4 doses)
  • Chlorambucil ± rituximab
  • Cyclophosphamide ± rituximab
  • Chlorambucil ± rituximab
  • Ibritumomab tiuxetang (category 2B)

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