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Could patients with smIPI > 1 and poor tolerability to RCHOP be offered ISRT after 3 cycles of RCHOP if interim PET showed 5-PS 1-3 response?
Given that older versions of NCCN guidelines for DLBCL recommended 3 cycles of R-CHOP before interim restaging and radiation therapy for nonbulky, Stage I DLBCL, what prompted the change in the guidelines so that smIPI 0-1 would have a different treatment pathway than smIPI > 1?
Answer from: Radiation Oncologist at Academic Institution
The FLYER and LYSA/GOELAMS studies have significantly influenced the management of DLBCL. Although the studies were quite different, they both demonstrated that patients with non-bulky, stage I-II DLBCL and a favorable IPI do very well with 4 cycles of R-CHOP alone. For patients with 0 or 1 stage-mo...
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