Diffuse large B cell lymphoma medical therapy

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3)Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2], Sowminya Arikapudi, M.B,B.S. [3]


The optimal therapy for diffuse large B cell lymphoma depends on the stage at diagnosis,age, IPI (International Prognostic Index) and aaIPI (Age adjusted International Prognostic index). The predominant therapy for diffuse large B cell lymphoma is chemotherapy. Adjunctive radiotherapy may be required. Inclusion in a clinical trial is recommended when available.

Medical Therapy


Main treatment of Choice for DLBCL. Chemotherapy is administered intravenously and people receiving chemotherapy commonly have a (peripherally inserted central catheter) in their arm near the elbow or a surgically implanted medical port. It is most effective when it is administered multiple times over a period of months (e.g. every 3 weeks, over 6 to 8 cycles). Different regimens of Chemotherapy with different durations/Cycles are used depending on the stage of disease, age of patient and prognsotic index. In general

  • Patients with limited stage disease receive 3 cycles of therapy
  • Patients with extensive disease 6 or 8 cycles of chemotherapy. In the United States, 6 cycles is the preferred approach rather than 8 cycles.

Radiation therapy

Radiation is often added in the treatment. It is used commonly after completing 3 cycles of treatment in limited stage disease. In extensive disease, after 6-8 cycles of chemotherapy, radiation can be used at the end of the treatment to areas of bulky involvement. Radiation therapy alone is not an effective treatment for this disease

Stem Cell Transplantation

High dose Chemotherapy coupled with stem cell transplantation is sometimes used to treat patients whose disease is refractory or relapsed following initial chemotherapy. Most common is Autologous stem cell transplant in which patients receive their own stem cells. Other option is Allogenic stem cell transplant in which patient will receive stem cells from a donor

Regimens of Chemotherapy


  • Standard treatment is CHOP-R, also referred to as R-CHOP, an improved form of CHOP with the addition of rituximab (Rituxan), which has increased the rates of complete responses for Diffuse large B cell lymphoma patients, particularly elderly patients.[1][2][3]

R-CHOP is a combination of one monoclonal antibody, 3 chemotherapy drugs and one steroid:[4]


Alternate Intensive immmunochemotherapy that is preferred in patients with an age-adjusted IPI score of 1. However, its clinically significant toxic adverse effects have limited its use. It is a combination of:


Limited-Stage Disease (stage I or II disease, non-bulky and localized) with Age Younger Than 60 Years and Low IPI ( 0 )

  • This represents about 30% of patients
  • Those patients often have low-risk clinical features and a favorable outcome
  • Four Cycles of R-CHOP are enough[5]
  • Radiotherapy Consolidation treatment has no proven benefit in patients with non-bulky disease. It may cause late relapses and second cancers

Patients Who Are Not Candidate For Standard Therapy

Central Nervous System Prophylaxis

Management of Refractory or Relapsed Cases

  • Primary refractory disease (i.e., an incomplete response or a relapse within 6 months after therapy) occurs in about 10-15% of patients treated with R-CHOP
  • Approximately 20-25% will develop a relapse after the initial response, often within the first 2 years[11]
  • Failure of frontline treatment indicates poor outcome with a median overall survival of about 6 months[12]
  • Patients with late relapses (more than 2 years after treatment) have better outcomes

Transplantation-Eligible Patients

Transplantation-Ineligible Patient

  • This includes patients with advanced age or coexisting medical conditions, those who are refractory to salvage therapy, and those with a relapse following ASCT
  • Palliative therapy can be achieved by sequential single-agent chemotherapy or a multiagent regimen with an acceptable side effect profile

CAR T-Cell Therapy

Novel Therapies



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