title: Management of nodal diffuse large B-cell lymphomas: practice guidelines from the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation.
abstract: The Italian Society of Hematology (SIE) and two affiliate societies (SIES and GITMO) commissioned a project to develop clinical practice guidelines for the treatment of nodal diffuse large B-cell non Hodgkin lymphomas (DLBCL). Key questions clinically relevant to the management of patients with nodal DLBCL were formulated by an Advisory Committee (AC) and approved by an Expert Panel (EP) composed of eight senior hematologists. After a comprehensive and systematic literature review, the EP formulated therapy recommendations and graded them according to the supporting evidence. An explicit approach to consensus methodologies was used for evidence interpretation and for producing recommendations in the absence of strong evidence. The EP formulated recommendations on which first-line therapy to choose in patients with nodal DLBCL. Patients of all ages, with stage I-II disease and no adverse prognostic factors should receive abbreviated chemotherapy with an anthracycline-containing regimen plus involved field radiotherapy (35-40 Gy). Patients with stage I-II disease and at least one adverse prognostic factor, or with stage III-IV disease, should receive frontline chemoimmunotherapy with CHOP, CHOP-like or third-generation chemotherapy plus rituximab. Recommendations on stem cell transplantation and on which therapy to adopt for refractory or relapsed patients were also formulated.
authors.affiliation: Laboratory of Clinical Epidemiology, IRCCS Policlinico S.Matteo, Pavia, Italy. barosig@smatteo.pv.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barosi
authors.forename: Angelo
authors.initials: A
authors.lastname: Carella
authors.forename: Mario
authors.initials: M
authors.lastname: Lazzarino
authors.forename: Monia
authors.initials: M
authors.lastname: Marchetti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Martelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Corrado
authors.initials: C
authors.lastname: Tarella
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Zinzani
authors.forename: Sante
authors.initials: S
authors.lastname: Tura
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D019468:Disease Management; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007558:Italy; D008198:Lymph Nodes / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents