Diffuse Large B-Cell Lymphoma (DLBCL) is the most common form of non-Hodgkin lymphoma, accounting for up to 30 percent of newly diagnosed cases. DLBCL is an aggressive lymphoma. It can arise in lymph nodes or outside of the lymphatic system, in the gastrointestinal tract, testes, thyroid, thymus gland, skin, breast, bone, or brain.
Certain factors can predict risk of relapse of DLBCL, including age at diagnosis, blood levels of specific proteins, a person’s ability to function without help, the disease stage, and whether the lymphoma cells appear in organs outside of the lymphatic system.
Because DLBCL advances very quickly, it usually requires immediate treatment. A combination of chemotherapies and the monoclonal antibody rituximab (Rituxan) can lead to a cure in a large number of people with this form of lymphoma. The most widely used treatment for DLBCL is R-CHOP, which is a mixture of rituximab (Rituxan) and several chemotherapy drugs (cyclophosphamide, doxorubicin, vincristine and prednisone). Etoposide sometimes is added to R-CHOP, resulting in a drug combination called R-EPOCH. For patients with refractory disease (disease that does not respond to treatment) or relapsed disease (disease that returns after treatment), secondary therapies such as a stem cell transplant may be used and in many cases can be curative.
More recent studies show that the best first line treatment for DLBCL depends upon the patient’s molecular subtype. Patients with activated b-cell like (ABC) or primary mediastinal b-cell lymphoma may do better with dose adjusted EPOCH and Rituxan with or without another drug added to the regimen. Patients with germinal center b-cell lymphoma generally respond well to R-CHOP. Once again, we are able to differentiate cancer subtypes much better now and that favorably impacts treatment and survival rates.