Info
management of Diffuse large B-cell lymphoma
- DLBCL Cure Rate:
- DLBCL is → curable w/ chemotherapy, even in advanced stage.
- Standard Treatment:
- Standard of care for advanced stage disease is → rituximab + CHOP (cyclophosphamide, doxorubicin, vincristine & prednisone) every 3 wks for 6-8 cycles (NEJM 2002;346:235).
- Cardiotoxicity Risk:
- LV function is → screened w/ MUGA or ECHO before doxorubicin due to risk of cardiotoxicity.
- Infusional Regimen:
- Cardiac tox lower w/ the infusional regimen dose-adjusted EPOCH.
- Interim Restaging:
- Interim restaging (investigational, CT vs. PET) after 2-4 cycles. Consider Rx change if <PR. We recommend interim CT because of issue w/ false positive PET scanning.
- Role of Radiation Therapy:
- RT improves local control, particularly for bulky disease. ISRT has replaced traditional IFRT as the current standard (NCCN Guidelines V 1.2013, pg NHODG-D).
- CNS Relapse Prevention:
- Intrathecal or high-dose MTX Ppx if ↑ risk of CNS relapse (testis involvement, epidural space, primary breast, high risk IPI, double-hit) (JCO 2015;36:3150).
- Post-Treatment Evaluation:
- Restage w/ PET after completion of Rx (done 4-6 wks post tx to determine remission).