Management of patients with unresponsive diffuse large B cell lymphoma

This study reviewed recent recommendations in the management of patients with diffuse large B cell lymphoma (DLBCL).

DLBCL is the most common type of non-Hodgkin lymphoma (NHL). The current standard treatment includes chemotherapy and immunotherapy such as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). However, this treatment may fail in some patients. For these patients, treatment can be challenging. It is important to understand different types of treatment in order to successfully manage patients with unresponsive or relapsed DLBCL.

Patients who stop responding to the first treatment should undergo a new biopsy of the lymphoma to confirm the diagnosis. They should also receive new staging of the disease with PET scanning. 

Second-line treatment commonly include immunotherapy drugs such as rituximab (Rituxan) and chemotherapy. The goal is to chose a chemotherapy regimen that can give a high response and few side effects. One study of rituximab-containing treatment had an overall survival at 4 years of 48%. 50% of patients in this study who responded to treatment could proceed to a stem cell transplant (SCT).

Further studies which replaced rituximab with other treatments were not as effective. Adding rituximab to second-line treatment plans was found to improve survival without signs of disease. This was true especially in patients who did not receive rituximab as first-line treatment. One study compared rituximab treatment after SCT with SCT alone. They did not find any difference in survival between groups.

In patients who relapse, SCT is the recommended treatment. BEAM (carmustine, etoposide, cytarabine, melphalan) is the preferred treatment before SCT. However, carmustine is linked to lung side effects. One study compared BEAM with TEAM (thiotepa replacing carmustine) and found no differences in safety or effectiveness. For patients who do not respond to second-line treatment, options include a second SCT from a donor, chemotherapy, radiotherapy or drugs in clinical trials.

A new therapy with T-cells (a type of immune cells) is currently being researched. This involved changing the genes of a patient's T-cells outside the body and putting them back in to attack cancer cells. Some studies have shown overall response rates ranging from 59% – 88%.

This study reviewed different options for the management of patients with DLBCL.