–As soon as ANC (absolute neutrophil count) is more than 500, the next cycle of chemotherapy can be started

–Prognosis depends on the response rate to chemotherapy and to initial tumor stage

–Decrease in serum lactate dehydrogenate (LDH) level indicates the type of response to chemotherapy

–Overall long-term survival between 70 and 90%

6.10.2 Therapy and Prognosis of LL

•Therapy as in ALL: induction, consolidation with CNS-prophylaxis by intrathecal and/or high-dose chemotherapy or irradiation, followed by maintenance treatment

•Duration of chemotherapy: 1–3 years as in ALL depending on cell type and stage

•Prognosis: 80–90% long-term survival

– Thirty months after diagnosis relapse is unusual

6.10.3 Therapy and Prognosis of ALCL

•Therapy according to BL/LCBL or LL (see above)

•Results are similar to other NHL with 80% long-term survival

6.11Novel Immunologic Treatment

•Targeted monoclonal anti-CD 20 antibody (Rituximab) against surface protein of B-cells in conjuction with chemotherapy is being currently evaluated

•In ALCL monoclonal anti-CD 30 antibody and anti-ALK circulating antibodies in ALK-positive ALCL are in clinical evaluation

•Antitumor vaccination and tumor-specific cell therapies are being evaluated

6.12Patients with Partial Response or with Relapse of NHL

•Diagnosis and staging with biopsy as well as PET or PET/CT scanning

•Therapy:

–BL, BLL, LCBL: after reinduction [e.g., ifosfamide, cisplatin, etoposide (ICE)], high-dose chemotherapy with autologous or allogeneic stem-cell transplantation

–Alternative or adjuvant treatment: CD20 monoclonal antibody (Rituximab)

–In isolated relapse of CNS: conventional therapy and intrathecal chemotherapy (see above)

–In relapsed LL: after reinduction (see above) allogeneic stem cell transplantation (as in early relapse of ALL)