[Diagnosis and treatment of non-Hodgkin lymphoma in Netherlands: variation in guidelines and in practice].
OBJECTIVE
To investigate current guidelines for diagnosis and treatment of intermediate or high grade non-Hodgkin's lymphoma (NHL), stage I-IV (Burkitt's and lymphoblastic lymphoma excluded) and to compare this with current clinical practice.


METHODS
Descriptive.


METHODS
An inventory of guidelines for diagnosis and treatment of NHL of the Regional Cancer Centres (RCCs) was made in mid-1998, an enquiry containing questions about the practical situation concerning the diagnosis and treatment of NHL patients was sent to 59 internists-haematologists in non-university hospitals of the RCC regions Amsterdam, Rotterdam and South.


RESULTS
Apart from the standard diagnostics, the RCCs recommended several examinations for staging. For the initial staging the haematologists not always requested the recommended CTs of chest and abdomen and most of them did no restaging after the last course of chemotherapy. Half of them left the assessment of lymph node biopsy samples to a lymphoma panel. The recommended primary treatment consisted mainly of chemotherapy with cyclophosphamide-doxorubicin-vincristine-prednisone (CHOP). In certain regions, the schedule was slightly changed, with additional tenoposide and bleomycin (CHVmP/BV). The treatment schedules were heterogeneous, especially for stage I NHL. In leukopenia and/or thrombocytopenia, postponement was recommended, but dosage reduction was carried out immediately, especially in older patients, sometimes with administration of a haemopoietic growth factor. Recurrence NHL was treated in accordance with the guidelines with second-line chemotherapy, if possible followed by peripheral stem cell transplantation in a haematooncological centre.


CONCLUSIONS
Considering these results development of national guidelines for NHL would seem to be desirable.
Faber
L M
LM
Academisch Ziekenhuis Vrije Universiteit, afd. Hematologie, Amsterdam.
van Agthoven
M
M
Uyl-de Groot
C A
CA
Löwenberg
B
B
Huijgens
P C
PC
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006405:Hematology / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000188:drug therapy*; D008495:Medical Oncology / Q000706:statistics & numerical data; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires