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ACR Appropriateness Criteria® Diffuse Large B-Cell Lymphoma
Bouthaina S Dabaja1, Ranjana Advani, David C Hodgson
1*University of Texas MD Anderson Cancer Center, Houston, TX †American Society of Clinical Oncology, Stanford Cancer Center, Stanford, CA ‡Princess Margaret Hospital, Toronto, Ontario, Canada §University of Rochester Medical Center ‡‡‡University of Rochester Medical Center, Rochester †††American Society of Clinical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY ∥American Society of Clinical Oncology, Emory University, Atlanta, GA ¶Univeristy of Texas Health Science Center at San Antonio, San Antonio, TX #University of Florida Proton Therapy Institute, Jacksonville **University of Florida, Gainesville, FL ††American Society of Clinical Oncology, St. Jude Children's Research Hospital, Memphis, TN ‡‡University of Pennsylvania Health System, Philadelphia, PA §§Yale University School of Medicine, New Haven, CT ∥∥Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN ¶¶American Society of Hematology, University of Chicago, Chicago, IL ##Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD ***Massachusetts General Hospital, Boston, MA.
Abstract:
The management of diffuse large B-cell lymphoma depends on the initial diagnosis including molecular and immunophenotypic characteristics, Ann Arbor staging, and International Prognostic Index (IPI score). Treatment approaches with different chemotherapy regimens used is discussed in detail. The role of radiation as a consolidation is discussed including: (1) the prerituximab randomized trials that challenged the role of radiation, (2) recent prospective studies (UNFOLDER/RICOVER-60), and (3) retrospective studies; the last 2 showed a potential benefit of radiation both for early and advanced stage. The document also discusses the role of positron emission tomography/computed tomography for predicting outcome and potentially guiding therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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