Treatment recommendations for patients with diffuse large B-cell lymphoma

This article provided recommendations for the treatment of diffuse large B-cell lymphoma (DLBCL).

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL). It accounts for about 30% of new NHL cases in the U.S. Current treatments are effective in 60 – 70% of patients. However, about 30 – 40% of patients experience relapse (cancer recurrence) or develop refractory (does not respond to treatment) disease after first-line treatment.

For patients with stage 1 – 2 disease, R-CHOP rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy is the standard first-line treatment. Radiation therapy following R-CHOP is recommended for patients with bulky disease (tumors that are 5 centimeters or larger in size).

For patients with stage 3 – 4 disease, R-CHOP is the standard first-line treatment for low or intermediate-risk patients. Radiotherapy may also be used for patients aged 60 – 80 who have bulky disease. There is no standard treatment for high-risk patients. However, R-CHOP remains the typical treatment. Lower-dose chemoimmunotherapy is recommended for elderly patients.

Salvage (rescue) therapy is the next option for patients who relapse or develop refractory disease after first-line treatment. For patients younger than 60 – 70 and no other illnesses, immunochemotherapy is the treatment of choice. If a partial response (tumor shrinkage) is achieved, high-dose chemotherapy followed by autologous stem cell transplantation (autoSCT; transplant of the patient’s own healthy stem cells) is recommended.

For patients who relapse or develop refractory disease after autoSCT, allogeneic SCT (stem cells from a donor) is an option. For patients who are not good candidates for SCT, low to moderate intensity chemotherapy is recommended.

For patients with less common subtypes of DLBCL, treatment options vary. For plasmablastic lymphoma, CHOP (R-CHOP without rituximab) and DA-EPOCH (dose-adjusted R-CHOP with etoposide) may be recommended. Newer agents such as bortezomib (Velcade) and lenalidomide (Revlimid) may also be combined with these regimens. For primary mediastinal B-cell lymphoma (PMBL), R-CHOP and R-CHOEP (R-CHOP with etoposide) are recommended. More intense regimens such as DA-EPOCH with rituximab (Rituxan) may also be used.

For patients with DLBCL and HIV, immunochemotherapy is recommended. R-CHOP is preferred for these patients. Further treatment followed by autoSCT is recommended for patients who relapse.

This article provided recommendations for the treatment of DLBCL. Treatment options for plasmablastic lymphoma, PMBCL, and patients with HIV were also discussed.