Indolent, Stage I and Contiguous Stage II Adult Non-Hodgkin Lymphoma

Although localized presentations are uncommon in non-Hodgkin lymphoma (NHL), the goal of treatment should be cure of the disease in patients who are shown to have truly localized occurrence after undergoing appropriate staging procedures. Long-term disease control within radiation fields can be achieved in a significant number of patients with indolent stage I or stage II NHL by using dosages of radiation that usually range from 25 Gy to 40 Gy to involved sites or to extended fields that cover adjacent nodal sites.[1,2,3,4] The value of adjuvant chemotherapy (single-agent chlorambucil or doxorubicin-based combination chemotherapy), in addition to radiation to decrease relapse, has not been proven conclusively.[5,6]

When radiation therapy is contraindicated, chemotherapy can be employed for symptomatic patients (as outlined below for more advanced-stage patients), or watchful waiting can be considered for asymptomatic patients.[7]

Patients with involvement not encompassable by radiation therapy are treated as outlined for patients with stage III or stage IV low-grade lymphoma. Follicular large cell and mantle cell NHL are often treated as aggressive lymphomas (nodal and extranodal presentations).

Standard treatment options:

1. Involved-field radiation therapy.[1,2,3,4]
2. Watchful waiting.[7]
3. Chemotherapy with radiation therapy.[6]
4. Extended (regional) radiation therapy to cover adjacent prophylactic nodes.[1,2,3,4,8]
5. Rituximab, an anti-CD20 monoclonal antibody, either alone or in combination with chemotherapy and extrapolated from trials of patients with advanced-stage disease.
6. Other therapies as designated for patients with advanced-stage disease.

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with indolent, stage I adult non-Hodgkin lymphoma and indolent, contiguous stage II adult non-Hodgkin lymphoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

1. Mac Manus MP, Hoppe RT: Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University. J Clin Oncol 14 (4): 1282-90, 1996.
2. Vaughan Hudson B, Vaughan Hudson G, MacLennan KA, et al.: Clinical stage 1 non-Hodgkin's lymphoma: long-term follow-up of patients treated by the British National Lymphoma Investigation with radiotherapy alone as initial therapy. Br J Cancer 69 (6): 1088-93, 1994.
3. Denham JW, Denham E, Dear KB, et al.: The follicular non-Hodgkin's lymphomas--I. The possibility of cure. Eur J Cancer 32A (3): 470-9, 1996.
4. Haas RL, Poortmans P, de Jong D, et al.: High response rates and lasting remissions after low-dose involved field radiotherapy in indolent lymphomas. J Clin Oncol 21 (13): 2474-80, 2003.
5. Kelsey SM, Newland AC, Hudson GV, et al.: A British National Lymphoma Investigation randomised trial of single agent chlorambucil plus radiotherapy versus radiotherapy alone in low grade, localised non-Hodgkins lymphoma. Med Oncol 11 (1): 19-25, 1994.
6. Seymour JF, Pro B, Fuller LM, et al.: Long-term follow-up of a prospective study of combined modality therapy for stage I-II indolent non-Hodgkin's lymphoma. J Clin Oncol 21 (11): 2115-22, 2003.
7. Advani R, Rosenberg SA, Horning SJ: Stage I and II follicular non-Hodgkin's lymphoma: long-term follow-up of no initial therapy. J Clin Oncol 22 (8): 1454-9, 2004.
8. Ha CS, Kong JS, Tucker SL, et al.: Central lymphatic irradiation for stage I-III follicular lymphoma: report from a single-institutional prospective study. Int J Radiat Oncol Biol Phys 57 (2): 316-20, 2003.