1. Treatment guideline and algorithm for Advanced Stage Follicular and Nodal Marginal Zone* Lymphomas All patients should be considered for, and offered, NRCN/ MRC clinical trials at diagnosis and relapse
Clinical scenario
Patient fit
Fit for transplant
Patient less fit
Fit for R-chemo but not transplant
Patient unfit
Not fit for R-chemo
Asymptomatic + low tumour burden
Watch & wait
First line
R-CVP (or R-CHOP) followed by R maintenance
PACIFICO for patients aged 60+
(R-CVP x 8 v R-FC x 4 followed by R maintenance)
Rituximab
Second line
R-based salvage followed by R-CHOP or R-B
Autograft or allograft
Clinical trial if available
Low-dose chlorambucil and/or prednisolone if not
Third line or if evidence of high-grade transformation
R-based salvage followed by autograft or allograft
Clinical trial
Fourth line
Fifth line
Ibritumomab Tiuxetan (Zevalin)*
Not applicable
Prepared by: Professor A Pettitt and Dr A Arumainathan RLBUHT; November 2011
Updated Feb 2013
* Check MCCN quick guide to funding and for status of specific therapies