What are the NCCN recommendations for the treatment stage II/III bulky disease of diffuse large B-cell lymphoma (DLBCL) non-Hodgkin lymphoma (NHL)?

Updated: Jun 12, 2019
  • Author: Priyank P Patel, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

For stage III/IV (advanced-stage) disease, NCCN treatment recommendations are as follows [1] :

  • R-CHOP every 21 days for six cycles is preferred

  • Consider radiation therapy for bulky sites

  • Other regimens that may be considered include dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) plus rituximab or dose-dense R-CHOP-14

  • In patients at increased risk for central nervous system relapse (eg, disease involving the paranasal sinus, testis, epidural, bone marrow, HIV lymphoma, kidney or adrenal involvement or >2 extranodal sites, elevated LDH or concomitant expression of BCL2 and MYC protein), four to eight doses of intrathecal methotrexate and/or cytarabine, or 3-3.5 g/m2 of systemic methotrexate for prophylaxis is recommended


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