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When treating a patient with classic early stage diffuse large B-cell lymphoma (Stage I/II), when is it appropriate for patients to receive 3 versus 6 cycles of R-CHOP chemotherapy when the treatment is followed by ISRT?
The NCCN guidelines recommend all patients receive 3 cycles RCHOP followed by ISRT unless they have bulky disease greater than 7.5 cm. However, are there patients that need 6 cycles of R-CHOP chemotherapy versus 3 cycles (i.e. Bulky, extranodal, high IPI score, etc.) Does a patient's IPI score impact your recommendation for 3 versus 6 cycles of RCHOP chemotherapy?
Answer from: Radiation Oncologist at Academic Institution
The SWOG 8736 study included patients with stage I (bulky or non-bulky) and nonbulky stage II aggressive non-Hodgkin lymphomas (mostly DLBCL). Bulky was defined as a mediastinal mass >1/3 maximal chest diameter or any mass > 10 cm. Patients were randomized to 8 cycles of CHOP or 3 cycles of CH...
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