Guidelines on Diagnosis and Treatment of Malignant Lymphomas

CODOX-M, (3 cycles) for low risk disease and CODOX-M/IVAC
(2 cycles) for high risk disease is the current treatment of choice.
Dose intensity is vital for optimal outcome and treatment should
be given in full doses without delays. Cure rates with this
approach are 90% for low risk disease and 60% for high risk
disease. There is no randomised control trial evidence for the
addition of Rituximab; however it is active in BL and its use is
logical. Patients who relapse generally die and there is no proven
indication for high-dose treatment strategies.
Response Evaluation
The key factor is to deliver treatment with maintenance of
dose intensity. The patient should be assessed with CT scan,
BM aspirate and CSF after the first course of chemotherapy
to ensure remission. At the end of treatment, tests which
were abnormal at diagnosis such as CT scan, bone marrow
or CSF examination should be repeated.
Follow Up
Relapse is usually seen within one year and patients remaining
free of disease at two years can be considered cured. Rare
late “relapses” due to the evolution of a second BL clone
have been described.
Monthly follow up for first 6 months, 2 monthly for 6 months,
4 monthly for a year and then annual follow up is recommended,
with particular attention to late effects.
Female patients usually maintain fertility following CODOX-
M/IVAC but the fertility outcome for post-pubertal males
is unclear.
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