A 78-year-old woman with a history of type 2 diabetes treated with oral antidiabetics, hypertension treated with beta-blockers and ACE inhibitors, and NYHA grade 1 congestive heart failure with LVEF of 48%, and currently asymptomatic. Functional status: ECOG 0. History of 2 years of evolution of small lumps in the neck. Biopsy of cervical adenopathy: follicular lymphoma grade 2. Extension study: Hb 12 g/dL, Leukocytes 6,900/microL (Neutrophils 60%, Lymphocytes 27%, Monocytes 6%, Eosinophils 4%, Basophils 4%), Platelets 220,000/microL. MO: infiltrate by follicular lymphoma. Creatinine 1.5 mg/dL, LDH 235 U/L, Beta2 microglobulin 2.1 microg/mL. CT: lymphadenopathies less than 3 cm in cervical, axillary, retroperitoneal, iliac and inguinal territories; liver and spleen are normal. Which of the following treatments is the most appropriate?
There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy, but given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing, unless GELF criteria are met to initiate treatment: GELF criteria (Follicular Lymphoma Study Group): - Involvement of ≥3 nodal areas, each with a diameter ≥ 3 cm. - Any nodal or extranodal mass with a diameter ≥ 7 cm. - B symptoms. - Splenomegaly. - Pleural effusion or ascites. - Cytopenias (leukocytes < 1.0 x 109 / L and/or platelets < 100 x 109 / L). - Leukemia (> 5.0 x 109 /L of malignant cells).
Rituximab-CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisone).
Rituximab-CVP (Cyclophosphamide, Vincristine, Prednisone).
Do not treat and monitor (wait and see).
Rituxirnab-Bendamustine.
There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy, but given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing,
There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy, but given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing,
There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy, but given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing,
There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy, but given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing,