Diffuse large B cell lymphoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2], Anila Hussain, MD [3]
Overview
The optimal therapy for diffuse large B cell lymphoma depends on the stage at diagnosis. The predominant therapy for diffuse large B cell lymphoma is chemotherapy. Adjunctive radiotherapy may be required.
Medical Therapy
Chemotherapy
- Standard treatment is CHOP-R, also referred to as R-CHOP, an improved form of CHOP with the addition of rituximab (Rituxan), which has increased the rates of complete responses for Diffuse large B cell lymphoma patients, particularly elderly patients.[1][2][3]
- R-CHOP is a combination of one monoclonal antibody, 3 chemotherapy drugs and one steroid:[4]
- Rituximab (Rituxan)
- Cyclophosphamide (Cytoxan)
- Doxorubicin (Hydroxydaunorubicin)
- Vincristine (Oncovin)
- Prednisone
- Chemotherapy is administered intravenously and is most effective when it is administered multiple times over a period of months (e.g. every 3 weeks, over 6 to 8 cycles). The number of cycles of chemotherapy given depends on the stage of the disease.
- Patients with limited stage disease receive 3 cycles of therapy
- Patients with extensive disease 6 or 8 cycles of chemotherapy. In the United States, 6 cycles is the preferred approach rather than 8 cycles.
A new development is obtaining a PET scan after completing two cycles of chemotherapy, to help make further decisions after chemotherapy.
Elderly
The elderly are usually unable to tolerate therapy well. Multiple lower intensity regimens have been attempted in this age group.[5]
People receiving chemotherapy commonly have a (peripherally inserted central catheter) in their arm near the elbow or a surgically implanted medical port.
Radiation therapy
Radiation is often added in the treatment. It is used commonly after completing 3 cycles of treatment in limited stage disease. In extensive disease, after 6-8 cycles of chemotherapy, radiation can be used at the end of the treatment to areas of bulky involvement. Radiation therapy alone is not an effective treatment for this disease.
References
- ↑ Sehn, L. H.; Berry, B.; Chhanabhai, M.; Fitzgerald, C.; Gill, K.; Hoskins, P.; Klasa, R.; Savage, K. J.; Shenkier, T.; Sutherland, J.; Gascoyne, R. D.; Connors, J. M. (2007). "The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP". Blood. 109 (5): 1857–61. doi:10.1182/blood-2006-08-038257. PMID 17105812.
- ↑ Miyazaki K (2016). "Treatment of Diffuse Large B-Cell Lymphoma". J Clin Exp Hematop. 56 (2): 79–88. doi:10.3960/jslrt.56.79. PMID 27980306.
- ↑ http://cornell-lymphoma.com/tag/dlbcl/[full citation needed]
- ↑ Farber, Charles M.; Axelrod, Randy C. (2011). "The Clinical and Economic Value of Rituximab for the Treatment of Hematologic Malignancies". Contemporary Oncology. 3 (1).
- ↑ Zaja, F.; Tomadini, V.; Zaccaria, A.; Lenoci, M.; Battista, M.; Molinari, A. L.; Fabbri, A.; Battista, R.; Cabras, M. G.; Gallamini, A.; Fanin, R. (2006). "CHOP-rituximab with pegylated liposomal doxorubicin for the treatment of elderly patients with diffuse large B-cell lymphoma". Leukemia & Lymphoma. 47 (10): 2174–80. doi:10.1080/10428190600799946. PMID 17071492.