1. Please review the following table, make any changes you think are necessary and highlight those changes. Feel free to put notes on the next page

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1 COME HOME Non-Hodgkin pathway development worksheet, v6 September Please review the following table, make any changes you think are necessary and highlight those changes. Feel free to put notes on the next page Test Name (CT, MRI, KRAS, etc.) CLL/SLL Follicular Marginal Zone s Mantle Cell Diffuse Large B-Cell Burkitt H&P All pts. All pts. All pts. All pts. All pts. All pts. Performance Status All pts. All pts. All pts. All pts. All pts. All pts. B symptoms All pts. All pts. All pts. All pts. All pts. CBC, differential, All pts. All pts. All pts. All pts. All pts. All pts. platelets LDH All pts. All pts. All pts. All pts. All pts. All pts. Comprehensive All pts. All pts. All pts. All pts. All pts. All pts. metabolic panel Hepatitis B testing If using CD20 antibody All pts. If considering rituximab If considering rituximab All pts. All pts. Evaluation of ejection If anthracycline- or anthracenedione-based regimen is indicated fraction Pregnancy test Women of child bearing age Quantitative Optional Optional immunoglobulins Reticulocyte count Optional Diagnostic Chest/ abdominal/pelvic CT Optional All pts. All pts. All pts. All pts. All pts. Beta-2-microglobulin Optional All pts. Optional All pts. Uric Acid Optional Optional Optional All pts. All pts. Bone Marrow Biopsy Optional Stage I-II Gastric: Optional Nongastric: Optional Nodal: Required Splenic: Required All pts. All pts. (> 1.6 cm biopsy) All pts. PET-CT Optional Optional Nongastric: Optional Nodal: Optional Splenic: Optional Optional All pts. Optional FISH Pts with Optional Optional Optional Optional Optional good PS Neck CT Optional Optional Optional Optional 1

2 Test Name (CT, MRI, KRAS, etc.) CLL/SLL Follicular Marginal Zone s SPEP Optional Gastric: Optional Nongastric: Optional Nodal: Optional Splenic: Required Hepatitis C Testing Optional Gastric: Optional Nongastric: Optional Nodal: Optional Splenic: Required H.pylori testing Gastric Endoscopy Gastric: Required Nongastric: Optional Mantle Cell Optional Diffuse Large B-Cell Burkitt MRI Nongastric: Optional Optional Brain MRI Optional Cryoglobulins Splenic: Optional Direct Coombs testing Splenic: Optional Colonoscopy Optional Lumbar puncture Blastic variant/cns symptoms Optional All pts. IPI calculation All pts. Head CT Optional HIV test Optional All pts. Flow cytometry of cerebrospinal fluid All pts. 2

3 A new group of lymphomas starts below: Test Name (CT, MRI, KRAS, etc.) H&P Primary Cutaneous B- Cell All pts.: incl. skin exam Peripheral T-Cell All pts.: incl. skin exam Adult T-Cell Leukemia/ All pts.: incl. skin exam T-Cell Prolymphocytic Leukemia All pts.: incl. skin exam 3 Hairy Cell Leukemia All pts. Performance Status All pts. All pts. All pts. All pts. All pts. B symptoms All pts. CBC, differential, All pts. All pts. All pts. All pts. platelets LDH All pts. All pts. All pts. All pts. All pts. Comprehensive All pts. All pts. metabolic panel Hepatitis B testing If rituximab considered If rituximab considered Evaluation of ejection If anthracycline- or anthracenedione-based regimen is indicated fraction Pregnancy test Women of child bearing age Quantitative immunoglobulins Optional PCMZL Reticulocyte count Diagnostic Chest/ abdominal/pelvic CT All pts. And/or PET- CT, All pts All pts. All pts. Optional Beta-2-microglobulin Uric Acid All pts. Bone Marrow Biopsy Required if PC-DLBCL, Leg type, Optional otherwise All pts. Optional All pts. PET-CT Optional And/or Dx Optional Optional CT, All pts. FISH Optional Optional Optional Optional Optional Peripheral blood flow If CBC cytometry demonstrates lymphocytosis SPEP Optional PCMZL Calculation of IPI All pts.

4 Test Name (CT, MRI, KRAS, etc.) Primary Cutaneous B- Cell Peripheral T-Cell Neck CT Optional Head CT Optional Head MRI Optional Skin biopsy Optional HIV Test Optional Electrolytes, BUN, creatinine, serum calcium Adult T-Cell Leukemia/ All pts. T-Cell Prolymphocytic Leukemia All pts., calcium not required Upper GI endoscopy Optional Skeletal Survey Optional Stool examination for Optional parasites CNS evaluation by CT, Optional MRI or LP HTLV-1 serology Optional Screen for active infections and CMV serology Peripheral blood examination If alemtuzumab is considered Hairy Cell Leukemia Optional 4

5 Mantle Cell Stage I-II 5

6 Mantle Cell Stage IIx, III, IV Yes High-dose therapy with autologous stem cell rescue RT and or any of the regimens below R-HyperCVAD NORDIC Complete Response Candidate for HDT/ASCR? No Treated with RCHOP Yes No Rituximab maintenance Follow Up Relapse Mantle Cell Stage Iix, III, IV CALGB Sequential RCHOP/RICE Alternating RCHOP/RDHAP Bendamustine + rituximab Cladribine + rituximab CVP + rituximab Dose-adjusted EPOCH + rituximab RCHOP Partial Response RT Bendamustine +/- rituximab Bortezomib +/- rituximab Cladribine + rituximab FC FCMR FMR Lenalidomide +/- rituximab PCR PEPC +/- rituximab CR/ Improved PR No further response RT Bendamustine +/- rituximab Bortezomib +/- rituximab Cladribine + rituximab FC FCMR FMR Lenalidomide +/- rituximab PCR PEPC +/- rituximab Ibrutinib Progression 6

7 Diffuse Large B-Cell Stage I-II Note: These guidelines may also be used for AIDS related B Cell, in conjunction with HART. 7

8 Diffuse Large B-Cell Stage III-IV 8

9 Diffuse Large B-Cell Relapse/refractory Disease 9

10 Burkitt 10

11 Chronic Lymphocytic Leukemia - CLL/ Small Lymphocytic - SLL Part 1 11

12 Chronic Lymphocytic Leukemia CLL/ Small Lymphocytic SLL Part 2 12

13 Follicular Stage I, II (initial therapy) 13

14 Follicular Stage II, III, IV (initial therapy) 14

15 Follicular Transformation Histologic transformation to diffuse B-cell lymphoma Clinical Trial Radioimmunotherapy Multiple prior therapies RCHOP Dose-dense RCHOP 14 Dose-adjusted EPOCH RCEPP RCDOP Responsive Disease Consider high dose therapy with autologous stem cell rescue or allogeneic stem cell transplant RCNOP RCEOP IFRT Histologic transformatoin to diffuse large B-cell lymphoma Best Supportive Care Clinical Trial CR Observe RCHOP Dose-dense RCHOP 14 Consider high dose therapy with autologous stem cell rescue or allogeneic stem cell transplant Minimal or no prior chemotherapy Dose-adjusted EPOCH RCEPP RCDOP PR Clinical Trial Consider radioimmunotherapy RCNOP RCEOP Consider high dose therapy with autologous stem cell rescue or allogeneic stem cell transplant Clinical Trial NR Radioimmunotherapy Best supportive care 15

16 Non-gastric MALT 16

17 Splenic MALT If Hepatitis C positive, and no contraindications to treatment, treat Hepatitis C as appropriate If lymphoma progresses, treat per guidelines for Follicular 17

18 Primary Cutaneous B Cell Marginal zone or follicle type 18

19 Primary Cutaneous Diffuse Large B Cell leg type 19

20 Peripheral T-Cell Initial Therapy Multi-agent Chemotherapy Options: CHOP-14 CHOP-21 CHOEP-21 CHOP followed by ICE CHOP followed by IVE alternating with intermediate-dose methotrexate Dose-adjusted EPOCH HyperCVAD alternating with high-dose methotrexate and cytarabine 20

21 Peripheral T-Cell Relapse/Refractory 21

22 Adult T-Cell Leukemia/ 22

23 T-Cell Prolymphocytic Leukemia Hairy Cell Leukemia 23