Treatment
This depends principally on clinical features, stage and accurate classification by histology including immunohistology and, where appropriate, cytogenetic or molecular studies. Paradoxically, aggressive B-cell tumours respond more dramatically to treatment and are more likely to be cured than indolent tumours. However, they are also rapidly progressive if untreated, frequently relapse and are associated with higher short- to medium-term mortality.
Aggressive
Localized (stage I or II) disease may be treated by deep X-ray therapy (DXT) with adjuvant combination chemotherapy (CCT) (e.g. three cycles of CHOP-R, a 21-day cycle of cyclophosphamide, hydroxydaunorubicin (Adriamycin), vincristine and prednisolone) with anti-CD20 monoclonal antibody (rituximab). Trials are in progress using chemotherapy alone to avoid long-term consequences of DXT. Advanced stage aggressive non-Hodgkin lymphoma (NHL) is treated with CCT (usually CHOP–rituximab, up to complete remission plus at least two cycles); PET and/or CT scan is valuable to assess whether or not full remission has been achieved (Fig. 35.1a,b). DXT to a single site of residual disease may be given.
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