Changes to This Summary (08/14/2012)
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.
General Information About Adult Non-Hodgkin Lymphoma
Updated statistics with estimated new cancer cases and deaths for 2012 (cited American Cancer Society as reference 1).
Cellular Classification of Adult Non-Hodgkin Lymphoma
Added text to state that follicular lymphoma in situ and primary follicular lymphoma of the duodenum are particularly indolent variants that rarely progress and rarely require therapy (cited Schmatz et al. and Jegalian et al. as references 24 and 25, respectively).
Revised text to state that therapy may be required to correct hemolytic anemia in patients with chronic cold agglutinin disease and rituximab, cyclophosphamide, and steroids are often employed.
Added text to state that the rise of IgM after rituximab can be avoided with the concomitant use of an alkylating agent such as cyclophosphamide or of the proteasome inhibitor bortezomib (cited Dimopoulos et al. as reference 44).
Added Laszlo et al. as reference 46.
Revised text to state that myeloablative therapy with autologous or allogeneic hematopoietic stem cell support is under clinical evaluation (cited Kyriakou et al. as reference 55).
Added Bayraktar et al. as reference 87.
Added Stefanovic et al. as reference 88.
Added Stretenovic et al. as reference 90.
Added Kempf et al. as reference 105.
Added Barrans et al. as reference 118.
Added text to state that the addition of rituximab to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)-based regimens has significantly reduced the risk of central nervous system (CNS) relapse in retrospective analyses (cited Villa et al. and Boehme et al. as references 123 and 124, respectively).
Added text to state for patients with relapse disease, brentuximab vedotin has shown anecdotal responses (cited Younes et al. as reference 144).
Revised text to state that the highly aggressive course has led some investigators to recommend autologous or allogeneic peripheral stem cell transplantation consolidation.
Added text to state that an L-asparaginase-containing regimen has shown anecdotal responses for relapsing patients (cited Jaccard et al. as reference 159).
Added text to state that a benign natural killer (NK)-cell enteropathy on endoscopic biopsy should be distinguished from NK-/T-cell lymphoma (cited Mansoor et al. as reference 161).
Added Weisenburger et al. as and Simon et al. as references 171 and 173, respectively.
Revised text to state that consolidation using high-dose chemotherapy with autologous or allogeneic hematopoietic stem cell support has been applied to patients with advanced-stage peripheral T-cell lymphoma after induction therapy with CHOP-based regimens.
Added text to state that for relapsing patients, the use of antifolate pralatrexate has shown a 30% response rate and a median 10-month duration of response for 109 evaluable patients in a prospective trial (cited O'Connor et al. as reference 175 and level of evidence 3iiiDiv).
Added Di Sabatino et al. as reference 192.
Added Salaverria et al. as reference 202.
Added text to state that adult T-cell leukemia/lymphoma (ATL) has been divided into four clinical subtypes: acute, lymphoma, chronic, and smoldering (cited Shimoyama et al. and Takasaki et al. as references 221 and 222, respectively). Also added that the acute and lymphoma types of ATL have done poorly with strategies of combination chemotherapy and allogeneic stem cell transplantation (cited Yamada et al. and Fukushima et al. as references 223 and 224, respectively).
Revised text to state that the combination of zidovudine and interferon-alpha, which has activity against the leukemic subtype, and sometimes the smoldering and chronic forms of ATL; added that durable remissions are seen in the majority of presenting patients with this combination but are not seen in patients with the lymphoma subtype of ATL (cited 2010 Bazarbachi et al. and 2011 Bazarbachi et al. as references 229 and 230, respectively).
Added Pérez-Galán et al. as reference 234; also revised text to state that it is unclear which chemotherapeutic approach offers the best long-term survival in this clinicopathologic entity and that rituximab with CHOP or CHOP-like regimens is the usual first-line induction therapy; also added Griffiths et al. as reference 246.
Stage Information for Adult Non-Hodgkin Lymphoma
Added Salles et al. and Advani et al. as references 12 and 13, respectively.
Added Morton et al. as reference 12.
Added text to state that in addition to screening for human immunodeficiency virus among patients with aggressive lymphomas, prior infection with hepatitis B or hepatitis C should be assessed prior to treatment with rituximab and/or chemotherapy since reactivation of hepatitis may mandate antiviral therapy or discontinuation of rituximab (cited Niitsu et al. as reference 17).
Added Vitolo et al. as reference 31.
Indolent, Stage I and Contiguous Stage II Adult Non-Hodgkin Lymphoma
Added text to state that almost half of all patients treated with radiation therapy alone will relapse out-of-field within 10 years (cited Guadagnolo et al. as reference 5). Also revised text to state that the value of adjuvant treatment with rituximab or chemotherapy in addition to radiation to decrease relapse, has not been confirmed.
Added text to state that a retrospective analysis of the SEER database over 30 years showed improved outcomes for upfront radiation therapy, but one must be very cautious about this type of retrospective analysis. Watchful waiting has never been compared with upfront radiation therapy in a prospective randomized trial (cited Pugh et al. as reference 9).
Indolent, Noncontiguous Stage II/III/IV Adult Non-Hodgkin Lymphoma
Revised text to state that in three randomized prospective studies involving previously treated patients with relapsed indolent lymphoma, patients were randomly assigned to rituximab maintenance after retreatment with combination chemotherapy or observation alone; all trials showed prolongation of response duration (cited van Oers et al. and Martinelli et al. as references 24 and 26, respectively); also updated statistics of one trial that demonstrated improvement in median progression-free survival favoring maintenance rituximab (van Oers, level of evidence 1iiDiii).
Added text to state that in the PRIMA study, 1,019 previously untreated high-risk patients who required treatment achieved complete or partial response after induction therapy with immunochemotherapy and were then randomly assigned to 2 years of maintenance rituximab versus no maintenance (cited Salles et al. as reference 27 and level of evidence 1iiDiii); also added that at a median follow-up, progression-free survival favored rituximab maintenance with no difference in overall survival (OS).
Added text to state that many questions remain about rituximab maintenance, and the most salient question is whether a strategy of observation after induction with rituximab therapy at time of symptomatic progression is equivalent or superior to mandated rituximab maintenance (cited Friedberg et al. as reference 28).
Revised text of the ninth standard treatment option to include noncontiguous stage II patients (cited Jacobs et al. and Mendenhall et al. as references 72 and 73, respectively).
Aggressive, Noncontiguous Stage II/III/IV Adult Non-Hodgkin Lymphoma
Revised text to include statistics for a 10-year median follow-up (cited 2010 Coiffier et al. as reference 9).
Added Ziepert et al. as reference 23.
Added text to state that the addition of rituximab to CHOP-based regimens has significantly reduced the risk of CNS relapse in retrospective analyses (cited Villa et al. and Boehme et al. as references 40 and 41, respectively).
Added text to state that patients with bulky and extensive lymphadenopathy and elevations of serum uric acid and lactate dehydrogenase are at increased risk of tumor lysis syndrome resulting in metabolic derangements such as hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and subsequent acute renal failure (cited 2008 Coiffier et al. as reference 42). Also added that treatment options include: alkaline hydration; allopurinol; and rasburicase, a recombinant urate oxidase (cited Cortes et al. as reference 43).
Indolent, Recurrent Adult Non-Hodgkin Lymphoma
Revised text to state that durable responses to radiolabeled monoclonal antibodies before and after cytotoxic chemotherapy have also been reported (cited Link et al. as reference 22).
Revised text to state that in three randomized prospective studies involving previously treated patients with relapsed indolent lymphoma, patients were randomly assigned to rituximab maintenance after retreatment with combination chemotherapy or observation alone; all trials showed prolongation of response duration (cited van Oers et al. and Martinelli et al. as references 24 and 26, respectively); also updated statistics of one trial that demonstrated improvement in median progression-free survival favoring maintenance rituximab (van Oers, level of evidence 1iiDiii).
Aggressive, Recurrent Adult Non-Hodgkin Lymphoma
Added van Kampen et al. as reference 13.
Added text to state that in a randomized, prospective trial, 396 patients with diffuse large B-cell lymphoma in first relapse, or who were refractory to first-line therapy, received either R-ICE (rituximab, ifosfamide, etoposide, and carboplatin) or R-DHAP (rituximab, dexamethasone, high-dose cytarabine, and cisplatin) followed by autologous stem cell transplantation; there was no difference in 3-year event-free survival or OS (cited Gisselbrecht et al. as reference 16 and level of evidence 1iiA).
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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