Adult Non-Hodgkin Lymphoma Treatment (PDQ®)–Health Professional Version

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Changes to This Summary (08/11/2017)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Indolent Non-Hodgkin Lymphoma (NHL)

Revised text to state that in previously treated patients, the B-cell receptor-inhibitor ibrutinib was given to 94 symptomatic patients in two trials, with a response rate of 90% and a progression-free survival of 69% to 86% in 18 to 24 months (cited Dimopoulos et al. as reference 51).

Revised text to state that a prospective, randomized trial of 401 patients with nongastric, extranodal mucosa-associated lymphatic tissue compared chlorambucil alone versus rituximab plus chlorambucil versus rituximab alone; added that with a median follow-up of 7.4 years, the event-free survival was better for the rituximab-plus-chlorambucil arm (cited Zucca et al. as reference 89).

Aggressive NHL

Added text to state that in a retrospective review of 117 patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) who underwent autologous stem cell transplantation, the 4-year overall survival (OS) was 25% for double hit (rearrangement of bcl-2 and c-myc), 61% for double expressors (no rearrangement, but increased expression of bcl-2 and c-myc), and 70% for patients without these features (cited Herrera et al. as reference 17).

Revised text to state that therapy involves doxorubicin-based combination chemotherapy (such as CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone] or CHOPE [CHOP + etoposide]), which is also used for DLBCL. Added text to state that for patients with early-stage disease, anecdotal retrospective series disagree on the value of consolidative radiation therapy after combination chemotherapy (cited Briski et al. as reference 92 and level of evidence 3iiiDiv).

Revised text to state that treatment of Burkitt lymphoma/diffuse small noncleaved-cell lymphoma involves aggressive multidrug regimens in combination with rituximab, similar to those used for the advanced-stage aggressive lymphomas (cited Ribrag et al. as reference 128). Also added that patients with HIV-associated Burkitt lymphoma also benefit from less-toxic modification of the aggressive multidrug regimens in combination with rituximab (cited Noy et al. as reference 134 and level of evidence 3iiiDiv).

Added text to state that in a multicenter phase II study of 26 relapsed patients, 42% responded to lenalidomide (including four complete responses) (cited Ishida et al. as reference 154 and level of evidence 3iiiDiv).

Added text to state that a prospective randomized trial of 497 patients younger than 65 years compared six cycles of R-CHOP (CHOP + rituximab) to six cycles of alternating R-CHOP and R-DHAP (rituximab, dexamethasone, cytarabine, and cisplatin), with both groups then receiving autologous stem cell transplantation; with a median follow-up of 6.1 years, the time to treatment failure was longer in the cytarabine group; however, the OS was not different (cited Hermine et al. as reference 169 and level of evidence 1iiDiii).

Added Trappe et al. as reference 185.

Revised text to state that instances of Epstein-Barr virus‒negative posttransplantation lymphoproliferative disorder occur even later (median, 5 years posttransplant) and have a worse prognosis; R-CHOP chemotherapy should be applied directly in this circumstance.

Treatment Option Overview for Adult NHL

Added Li et al. as reference 9.

Treatment for Indolent, Recurrent Adult NHL

Added obinutuzumab as a treatment option for indolent, recurrent adult NHL.

Revised the subsection on obinutuzumab.

Revised text to state that responses of 20% to 56% have been reported for lenalidomide, especially in patients with follicular lymphoma and small lymphocytic lymphoma, with even higher responses noted for the combination of lenalidomide and rituximab (cited Leonard et al as reference 25).

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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