Symptoms that signal when it might be time to start treatment

Fevers, drenching night sweats, weight loss, significant or progressive lymphadenopathy, involvement of the bone marrow that is significant that leads to cytopenias, or if the disease is threatening the function of an important organ are among the reasons to start treatment, says Poh. There really isn't one universally best regimen for each patient, Poh notes, and the goal is to choose an effective treatment while minimizing toxicity and avoiding unnecessary treatment intensity. For patients with relatively low tumor burden, an anti-C20 antibody-based approach can be combined with chemotherapy or with a targeted agent, Poh says. Oncologists are increasingly incorporating chemotherapy-free approaches and rituximab combined with lenalidomide is now an established frontline option, she observes.