Treatment principles for lymphoma

The treatment principles for lymphoma are as follows:

1. Treatment principles of HL

Stage I: Subtotal lymph node irradiation (STNI), radical dose (4.5-50 Gy).

Stage IB, ⅡA-B: total lymph node irradiation (TNl), followed by MOPP combined with chemotherapy × 4 cycles.

For patients with stage III or I and II lymphocyte reduction type and large mediastinum (mediastinum invasion exceeds 1/3 of the transverse diameter of the chest cavity) or mass >5cm in diameter, first use MOPP chemotherapy for 3 cycles, then radiotherapy, whole lymph node irradiation, radical dose: followed by MOPP chemotherapy for 3 cycles.

Stages IIIB and 1V: Combination chemotherapy is the main treatment, with the following regimens: MOPP, ABVD, and MOPP/ABVD alternating. The dose intensity must be sufficient, for a total of 6 cycles or more (plus 2 cycles after complete remission), and local radiotherapy if necessary.

Splenectomy can be performed for patients with splenic invasion who have poor responses to chemotherapy and radiotherapy or who have hypersplenism.

Recurrence: For recurrence after radiotherapy remission, combined chemotherapy can achieve good therapeutic effects similar to those of initially treated cases; for recurrence after more than one year of remission after chemotherapy, the original chemotherapy regimen should be used. For those who relapse less than one year after remission after chemotherapy, the chemotherapy regimen should be changed, such as changing MOPP to ABVD, or changing ABVD to MOPP. If the patient is resistant to both MOPP and ABVD, the new chemotherapy regimen should be used.

For children and minors, adequate combined chemotherapy is the main treatment. If radiotherapy is required, 1/2 of the radical cure dose can be used, and the radiation field needs to be symmetrical.

The MOPP regimen affects fertility, so in some cases where fertility needs to be preserved, MOPP should not exceed 6 cycles.

(II) Principles of NHL treatment

1. Low-grade malignancy

1. Stage II: radiotherapy, subtotal lymph node irradiation, expanded field, radical dose. Stage III, IV: combined chemotherapy, COPP or CHOP regimen, local radiotherapy when necessary, or interferon injection, or whole body low-dose radiotherapy 150cGy/5 weeks. Sometimes the principle of observation and waiting is adopted, and treatment is performed when necessary. In short, the treatment should not be too aggressive.

2. Moderately malignant

IA-B, ⅡA stage: radiotherapy, whole lymph node irradiation. Radical dose, plus chemotherapy CHOP or BACOP × 4 cycles. ⅡB and ⅡA stage with extensive invasion: chemotherapy 2~3 cycles and radiotherapy, whole lymph node irradiation.

3. Highly malignant

Active systemic chemotherapy is the main treatment, with local radiotherapy when necessary. Bone marrow transplantation (BMT) or APBSCT and intensive chemotherapy with or without radiotherapy under CSF support. The treatment principle for low, medium and high malignant recurrence cases: either use more intensive chemotherapy than the original treatment plan, or change to a new chemotherapy plan, or intensive chemotherapy with or without radiotherapy under BMT, APBSCT, and CSF support.