Treatment recommendations

Question 1

Stage I-II No Adverse factors on IPI?

Answer 1

RCHOP x 3 cycles + IFRT

Question 2

Stage I-II with Adverse factors (Not Age > 60) or Bulky Disease?

Answer 2

RCHOP x 6 cycles + IFRT

Question 3

Stage III-IV?

Answer 3

RCHOP x 6 cycles and consider IFRT or transplant if a CR is not achieved

Question 4

When do you order a restaging PET/CT scan after chemo?

Answer 4

10-15 days after the last chemo cycle

Question 5

What special considerations are made for women and men who are still fertile

Answer 5

If able to bear children

1. Oophopexy should be discussed for women who will be treated with a pelvic field.
2. Sperm banking should be discussed for men who will be treated with a pelvic field.

Question 6

Relapsed or refractory DLBCL?

Answer 6

1. RICE x 3 cycles
2. PET/CT scan

if PET negative then High Dose chemo and autologous SCT

if PET positive but not sign of progression, then IFRT to 30.6 Gy, high dose chemo and autologous stem cell transplant

Question 7

Stage I - II with only Adverse factors > 60, non bulky.

Answer 7

RCHOP x 4 cycles + IFRT