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Posted by on Oct 5, 2019 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

This article reviewed treatment options for patients with diffuse large B-cell lymphoma (DLBCL). The authors concluded that further advancements in therapies and technology would allow for more personalized treatment in the future.

Some background

About 30 – 40% of cases of NHL are diffuse large B-cell lymphoma (DLBCL). R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy has remained the standard front-line treatment for DLBCL. Regimens containing rituximab have improved outcomes over the past several years.

Unfortunately, some patients do not respond to these therapies or experience relapse (cancer recurrence). This leaves an opening for the development of other treatments for DLBCL. Also, while the average age of diagnosis for patients with DLBCL is 70 years, many trials do not include this age group. More studies are needed for these patients.

Methods & findings

Recent studies have investigated whether adding other anti-cancer drugs can make R-CHOP more effective for the treatment of DLBCL. In the ongoing POLARIX study, patients with newly diagnosed DLBCL receive either R-CHOP or R-CHP with polatuzumab vedotin (Pola). Outcomes remain under investigation.

Another approach in treating DLBCL is to identify high-risk patients more accurately. One way is to detect DNA that contains genetic mutations found in tumors. This DNA can be found circulating in the bloodstream. One study of 217 patients found that this DNA was present in 98% of patients before treatment. After 2 cycles of chemotherapy, the levels of tumor DNA dropped. Low levels were associated with better survival outcomes.

Many studies exclude elderly patients over age 80. Treatment remains challenging for these patients. Lower-dose CHOP, also called mini-CHOP, may help avoid side effects associated with full-dose treatment. For very frail patients, regimens such as CVP that do not contain anthracyclines may be recommended. Lastly, G-CSF (granulocyte colony-stimulating factor) is recommended for patients aged 65 or older. This treatment helps prevent low white blood cell counts, which can be serious.

PMBCL is a rare but aggressive type of B-cell NHL, affecting mostly adolescents and young adults. Treatment can be difficult due to the potential for long-term complications in these young patients. Chemotherapy containing rituximab remains the standard of care.

The bottom line

This article reviewed treatment options for patients with DLBCL. The authors suggest that further research is needed to develop and evaluate novel therapies for these patients.

What’s next?

Talk to your care team about your treatment options.

Published By :

Current hematologic malignancy reports

Date :

Jun 29, 2019

Original Title :

Front-Line Treatment of High Grade B Cell Non-Hodgkin Lymphoma.

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