Treatment guideline and algorithm for Follicular and Nodal Marginal Zone* Lymphomas All patients should be considered for, and offered, NRCN/ MRC clinical trials at diagnosis and relapse Clinical scenario Patient fit Fit for transplant Patient less fit Fit for R-chemo but not transplant Patient unfit Not fit for R-chemo Asymptomatic + low tumour burden Watch & wait First line R-CVP (or R-CHOP) followed by R maintenance PACIFICO for patients aged 60+ (R-CVP x 8 v R-FC x 4 followed by R maintenance) Rituximab Second line R-CHOP or R-B followed by R maintenance Low-dose chlorambucil and/or prednisolone Third line or if evidence of high-grade transformation R-based salvage followed by autograft or allograft R-CHOP (attenuated if necessary) or FC-R lite Not applicable Fourth line Fifth line Ibritumomab Tiuxetan (Zevalin)* Prepared by: Professor A Pettitt and Dr A Arumainathan RLBUHT; November 2011 For review: November 2012 * Check MCCN quick guide to funding and http://www.nwcancerdrugsfund.nhs.uk/ for status of specific therapies