A treatment guide provided by NCCN Guidelines for Patients is available, while the NCCN Clinical Practice Guidelines in Oncology provides a reference for clinicians. Any proposed therapeutic strategy must have minimal acute and long-term toxicities. Watch and Wait Watchful waiting (watch and wait) was defined as a period of observation of at least 3 months without any treatment. Surgical Excision Surgical lymph node excision may be carried out at the time of diagnosis in certain cases such in children diagnosed at an early stage of progression. One study found sustained complete remission in half of the cases with a watch-and-wait strategy after surgical lymph node excision at the time of diagnosis. Radiation Therapy Studies indicate that radiation therapy (radio therapy) may reduce the risk of progression in adults. In one study, stage I-II patients treated with radiation therapy showed 10-year cause-specific survival of 98%, and the rate of developing radiotherapy-related second malignancies was not increased by the treatment (1% after 10 years). A study published in 2013 on large group of patients with early-stage<unk>  indicated support for using limited-field radiation therapy as the sole treatment of early-stage disease. In a study of 1,162<unk>  patients from the Surveillance, Epidemiology and End Results (SEER) cancer registry program, radiation therapy improved overall survival and disease specific survival. Immunotherapy An example antibody for use in immunotherapy is Rituximab. Rituximab has specific use in treatment of<unk>  as it is a chimeric monoclonal antibody against the protein CD20. Studies indicate Rituximab offers potential in relapsed or refractory patients, and also in front-line treatment especially in advanced stages. Because of a tendency for relapse, maintenance treatment such as every 6 months for 2 years is suggested. Rituximab has been shown to improve patient outcomes after histological transformation. Chemotherapy Possible options such as anthracycline-containing regimens include ABVD, BEACOPP and CHOP. Results of a trial with COPP/ABV in children suggested positive results with chemotherapy alone are possible without the need for radiation therapy. Optimal chemotherapy is a topic for debate, for example there is evidence of support for treatment with R-CHOP instead of ABVD, results showing high rates (40%) of relapse after 10 years since ABVD chemotherapy. BEACOPP has higher reported toxicity risk. Combined treatment One study reported combined radiation therapy (radio therapy) and antibody Rituximab. R-CHOP optionally followed by radiation therapy is recommended in newly diagnosed late stage disease, while for early stage disease radio therapy alone (stage IA without risk factors) or a brief ABVD-based chemotherapy followed by radiation therapy (early stages other than stage IA without risk factors) was advised.
Nodular lymphocyte predominant Hodgkin lymphoma
Indolent lymphoma
Pediatric-type follicular lymphoma
Epstein–Barr virus positive diffuse large B-cell lymphoma, not otherwise specified
Duodenal-type follicular lymphoma
Gray zone lymphoma
Aggressive lymphoma
Extranodal NK/T-cell lymphoma, nasal type