Describe the general treatment approach.
Perform prechemotherapy screening.
Select treatment based on the subtype of NHL, staging, and prognosis
Most patients will receive treatment with systemic chemotherapy and/or radiotherapy.
Low-grade NHL (initial stages): Consider radiotherapy with curative intent.
Low-grade NHL (advanced stages): usually palliative chemotherapy
High-grade NHL: usually chemotherapy with curative intent
Select patients may benefit from additional interventions, including splenectomy and hematopoietic stem cell transplantation (HSCT).
Describe the radiotherapy.
May be curative or palliative
Can be conventional or in form of radioimmunotherapy, in which engineered monoclonal antibodies that are specific for tumor antigens are bound to radioactive nucleotides, which results in higher doses of radiation reaching the target cancer cells and less off-target effects.
Describe systemic chemotherapy.
Regimens usually include combinations of chemotherapeutic agents, steroids, and immunotherapy.
Antifolates: high-dose methotrexate (in combination with leucovorin) for primary CNS lymphoma
Alkylating agents: e.g., cyclophosphamide (C)
Topoisomerase II inhibitors: e.g., etoposide (E), doxorubicin/hydroxydaunorubicin (H)
Alkaloids: e.g., vincristine/oncovin (V/O)
Steroids: e.g., prednisolone (P), dexamethasone
Immunotherapy: e.g., rituximab (R)
Describe intrathecal chemotherapy.
Intrathecal methotrexate can be considered for leptomeningeal involvement.
Treatment regimens overview (table).
Describe additional therapies.
Surgery
Splenectomy: Consider in select patients with B-cell lymphomas with splenic involvement (e.g., splenic MZL, hairy cell leukemia).
Surgical resection: Consider in select patients with specific NHL subtypes.
HSCT
Consider in relapsing or refractory disease for some NHL subtypes, e.g., DLBCL, mantle cell lymphoma, mature T-cell lymphoma.
Describe the prognosis.
Typically, the prognosis of NHL is worse than that of Hodgkin lymphoma. [25]
Low-grade lymphomas: median survival of 6–10 years
High-grade lymphomas: survival typically several months (years in less aggressive variants)
Indicators of poor prognosis: old age, number of involved nodal and extranodal sites, ↑ LDH, ↑ beta2 microglobulin
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