come home non-hodgkin lymphoma pathway development ......feb 27, 2015 · come home non-hodgkin...
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COME HOME Non-Hodgkin Lymphoma pathway development worksheet, v7 February 2015
1. Please review the following table, make any changes you think are necessary and highlight those changes. Feel free to put notes on the next page
Test Name (CT, MRI,
KRAS, etc.)
CLL/SLL Follicular
Lymphoma
Marginal Zone
Lymphomas
Mantle Cell
Lymphoma
Diffuse
Large B-Cell
Lymphoma
Burkitt
Lymphoma
H&P All pts. All pts. All pts. All pts. All pts. All pts.
Performance Status All pts. All pts. All pts. All pts. All pts. All pts.
B symptoms All pts. All pts. All pts. All pts. All pts.
CBC, differential,
platelets
All pts. All pts. All pts. All pts. All pts. All pts.
LDH All pts. All pts. All pts. All pts. All pts. All pts.
Comprehensive
metabolic panel
All pts. All pts. All pts. All pts. All pts. All pts.
Hepatitis B testing If using
CD20
antibody
All pts. If considering
rituximab
If considering
rituximab
All pts. All pts.
Evaluation of ejection
fraction
If anthracycline- or anthracenedione-based regimen is indicated
Pregnancy test Women of child bearing age
Quantitative
immunoglobulins
Optional Optional
Reticulocyte count Optional
Diagnostic Chest/
abdominal/pelvic CT
Optional All pts. All pts. All pts. All pts. All pts.
Beta-2-microglobulin Optional All pts. Optional All pts.
Uric Acid Optional Optional Optional All pts. All pts.
Bone Marrow Biopsy Optional Stage I-II Gastric: Optional
Nongastric: Optional
Nodal: Required
Splenic: Required
All pts. All pts.
(> 1.6 cm
biopsy)
All pts.
PET-CT Optional Optional Nongastric: Optional
Nodal: Optional
Splenic: Optional
Optional All pts. Optional
FISH Pts with
good PS
Optional Optional Optional Optional Optional
Neck CT Optional Optional Optional Optional
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Test Name (CT, MRI,
KRAS, etc.)
CLL/SLL Follicular
Lymphoma
Marginal Zone
Lymphomas
Mantle Cell
Lymphoma
Diffuse
Large B-Cell
Lymphoma
Burkitt
Lymphoma
SPEP Optional Gastric: Optional
Nongastric: Optional
Nodal: Optional
Splenic: Required
Hepatitis C Testing Optional Gastric: Optional
Nongastric: Optional
Nodal: Optional
Splenic: Required
H.pylori testing Gastric
Endoscopy Gastric: Required
Nongastric: Optional
Optional
MRI Nongastric: Optional Optional Brain MRI
Optional
Cryoglobulins Splenic: Optional
Direct Coombs testing Splenic: Optional
Colonoscopy Optional
Lumbar puncture Blastic
variant/CNS
symptoms
Optional All pts.
IPI calculation All pts.
Head CT Optional
HIV test Optional All pts.
Flow cytometry of
cerebrospinal fluid
All pts.
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A new group of lymphomas starts below:
Test Name (CT, MRI,
KRAS, etc.)
Primary
Cutaneous B-
Cell
Peripheral
T-Cell
Lymphoma
Adult T-Cell
Leukemia/
Lymphoma
T-Cell
Prolymphocytic
Leukemia
Hairy Cell
Leukemia
H&P All pts.: incl.
skin exam
All pts.: incl.
skin exam
All pts.: incl.
skin exam
All pts.: incl. skin
exam
All pts.
Performance Status All pts. All pts. All pts. All pts. All pts.
B symptoms All pts.
CBC, differential,
platelets
All pts. All pts. All pts. All pts.
LDH All pts. All pts. All pts. All pts. All pts.
Comprehensive
metabolic panel
All pts. All pts.
Hepatitis B testing If rituximab
considered
If rituximab
considered
Evaluation of ejection
fraction
If anthracycline- or anthracenedione-based regimen is indicated
Pregnancy test Women of child bearing age
Quantitative
immunoglobulins
Optional
PCMZL
Reticulocyte count
Diagnostic Chest/
abdominal/pelvic CT
All pts. And/or PET-
CT, All pts
All pts. All pts. Optional
Beta-2-microglobulin
Uric Acid All pts.
Bone Marrow Biopsy Required if
PC-DLBCL, Leg
type, Optional
otherwise
All pts. Optional All pts.
PET-CT Optional And/or Dx
CT, All pts.
Optional Optional
FISH Optional Optional Optional Optional Optional
Peripheral blood flow
cytometry
If CBC
demonstrates
lymphocytosis
SPEP Optional
PCMZL
Calculation of IPI All pts.
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Test Name (CT, MRI,
KRAS, etc.)
Primary
Cutaneous B-
Cell
Peripheral
T-Cell
Lymphoma
Adult T-Cell
Leukemia/
Lymphoma
T-Cell
Prolymphocytic
Leukemia
Hairy Cell
Leukemia
Neck CT Optional
Head CT Optional
Head MRI Optional
Skin biopsy Optional
HIV Test Optional
Electrolytes, BUN,
creatinine, serum
calcium
All pts. All pts., calcium
not required
Upper GI endoscopy Optional
Skeletal Survey Optional
Stool examination for
parasites
Optional
CNS evaluation by CT,
MRI or LP
Optional
HTLV-1 serology Optional
Screen for active
infections and CMV
serology
If alemtuzumab
is considered
Peripheral blood
examination
Optional
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Mantle Cell Lymphoma
Stage I-II
Rituximab Maintenance: Given every 8 weeks for 2 years.
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Mantle Cell Lymphoma
Stage IIx, III, IV
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Diffuse Large B-Cell Lymphoma
Stage I-II
Note: These guidelines may also be used for AIDS related B Cell Lymphoma, in conjunction with HART.
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Diffuse Large B-Cell Lymphoma
Stage III-IV
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Diffuse Large B-Cell Lymphoma
Relapse/refractory Disease
10
Burkitt Lymphoma
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Chronic Lymphocytic Leukemia - CLL/ Small Lymphocytic Lymphoma - SLL
Part 1
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Chronic Lymphocytic Leukemia CLL/ Small Lymphocytic Lymphoma SLL
Part 2
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Follicular Lymphoma
Stage I, II (initial therapy)
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Follicular Lymphoma
Stage II, III, IV (initial therapy)
Idelalisib- 150mg bid, given until progression.
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Follicular Transformation
Histologic transformation to diffuse B-cell lymphoma
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Non-gastric MALT
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Splenic MALT Lymphoma
If Hepatitis C positive, and no contraindications to treatment, treat Hepatitis C as appropriate
If lymphoma progresses, treat per guidelines for Follicular Lymphoma
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Primary Cutaneous B Cell Lymphoma
Marginal zone or follicle type
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Primary Cutaneous Diffuse Large B Cell Lymphoma
leg type
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Peripheral T-Cell Lymphoma
Initial Therapy
Multi-agent Chemotherapy Options:
CHOP-14
CHOP-21
CHOEP-21
CHOP followed by ICE
CHOP followed by IVE alternating with intermediate-dose methotrexate
Dose-adjusted EPOCH
HyperCVAD alternating with high-dose methotrexate and cytarabine
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Peripheral T-Cell Lymphoma
Relapse/Refractory
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Adult T-Cell Leukemia/Lymphoma
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T-Cell Prolymphocytic Leukemia
Hairy Cell Leukemia