Treatment guidelines for patients with B-cell lymphomas

This article provided guidelines for the treatment of patients with diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL).

DLBCL and FL are the most common types of non-Hodgkin’s lymphoma in adults. FL has the potential to transform into a more aggressive type of lymphoma. The most common transformation is to DLBCL. Approximately 15% of patients with FL experience this type of lymphoma transformation. This tends to be associated with poor outcomes. The current article gives recommended treatment options for patients with DLBCL or FL.

Chemoimmunotherapy remains the standard initial treatment for patients with FL. R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is one of the most common regimens. If the cancer comes back after this treatment, further chemoimmunotherapy may be recommended. For patients with a low tumor burden, rituximab (Rituxan) with or without other agents such as lenalidomide (Revlimid) can be used.

For patients with FL that comes back or stops responding to treatment, targeted therapy is recommended. This type of treatment specifically targets cancer cells without affecting healthy cells. This leads to fewer side effects. Idelalisib (Zydelig), copanlisib (Aliqopa), and duvelisib (Copiktra) block cancer cell division. This leads to cancer cell death. These agents are recommended for patients after 2 prior therapies for FL.

For patients with DLBCL that comes back or stops responding to treatment, high-dose chemotherapy followed by a stem cell transplant (SCT) is recommended. In one study of 1,039 patients, 51% of patients who had SCT were still alive 4 years later. Second-line treatment with combination chemotherapy may be recommended for patients before SCT. This can include rituximab combined with other agents, or radiotherapy.

Another treatment option for patients with DLBCL or FL that has come back or stopped responding to treatment is CAR-T cell therapy. In this treatment, T-cells (immune cells) are removed from the blood. The T-cells are genetically modified to make a special protein called CAR. This protein helps the T-cells attack cancer cells. These CAR T-cells are then reintroduced into the patient. This therapy can be highly effective. However, it is associated with serious side effects that may be life-threatening. More studies are needed to evaluate this treatment.

This article reviewed current recommendations for the treatment of patients with DLBCL or FL. Treatment options for patients with lymphoma that has come back or stopped responding to treatment are also discussed.