Classification of DLBCL
DLBCL, not otherwise specified
30% of non-Hodgkin lymphomas (NHLs) are of this type. These are more common among adults (with increased incidence seen between age 60-69), although the disease can develop at any age.
The disease appears suddenly in patients, although a small percentage of patients who develop this kind of lymphoma have existing HIV or another type of lymphoma such as indolent lymphoma or Hodgkin lymphoma.
The chances of this lymphoma being cured when first detected are high, and even many cases of recurring disease can be cured. When planning a treatment approach, it is important to assess comorbidities and the social circumstances of the patient, as over 40% are over age 65.
Use of the monoclonal antibody rituximab has had a marked impact on treatment of DLBCL when used with the CHOP-21 regimen—the gold standard—and has increased survival rates.
In localized stages (I-II), the chemotherapy and immunotherapy treatment followed is standard R-CHOP given over 6 cycles; this may be complemented with radiotherapy (when bulky disease is present)
In advanced stages (III-IV), comprehensive treatment is needed in order to have the highest chance of a cure. Therefore, the chemotherapy schemes are: CHOP (or one of its variants), R-CHOP, divided into 6 or 8 cycles. For patients who do not respond to R-CHOP treatment, intensification with autologous cells must be considered.
In case of relapse, the most widely used treatment schemes are DHAP, ESHAP, ICE, and miniBEAM. After immunotherapy began to be used with demonstrated effectiveness, rituximab was added to these combinations.
Patients with disease that is refractory to first-line treatment and those with recurrent/refractory disease should be considered for inclusion in a clinical trial.