How should I approach the management of a patient diagnosed with Non-Hodgkin Lymphoma in terms of treatment options and follow-up?

Treatment options for Non-Hodgkin Lymphoma (NHL) depend on the subtype and stage of the disease. For diffuse large B-cell lymphoma, first-line treatment typically involves chemotherapy, with consolidation using autologous or allogeneic stem cell transplantation considered for chemosensitive cases, especially if relapse occurs after autologous transplantation or if stem cell harvesting is not possible.

For Burkitt lymphoma, intensive immunochemotherapy regimens such as R-BFM, R-CODOX-M/R-IVAC, R-HyperCVAD (HDMTX), or R-LMB are recommended for fit patients, while less intensive regimens like R-CHOP, R-CHEOP, or DA-EPOCH-R may be used for those less fit.

Peripheral T-cell lymphoma is generally treated first-line with CHOP chemotherapy, with autologous stem cell transplantation consolidation for chemosensitive patients fit enough for transplantation.

Follicular lymphoma management varies by stage: localized stage IIA may be treated with local radiotherapy or watch and wait if asymptomatic; advanced-stage asymptomatic cases may receive rituximab induction therapy; symptomatic advanced-stage cases are treated with rituximab combined with chemotherapy regimens such as CVP, CHOP, MCP, CHVPi, or chlorambucil.

Follow-up after treatment for NHL involves regular clinical assessment, especially for diffuse large B-cell lymphoma patients in complete remission. Routine surveillance imaging and LDH testing to detect relapse are not recommended for asymptomatic patients. Clinical assessments may be stopped three years after treatment completion if remission is ongoing, but urgent appointments should be available if symptoms suggest relapse.

End-of-treatment summaries should be provided to patients and their GPs, including information on relapse signs, late effects, and lifestyle advice. After three years, surveillance of late effects may be transitioned to nurse-led or GP-led services.

Patient support and information are crucial throughout diagnosis, treatment, and follow-up. This includes clear communication about diagnostic tests, treatment benefits and risks, fertility, sexual function, psychological support, and access to wellbeing services. A named key worker should be assigned at diagnosis and during treatment, with contact details for the specialist team provided after treatment.