Canterbury DHB

Context

Diffuse Large B-Cell Lymphoma (DLBCL)

In This Section

Management

Management

This topic has been reviewed by Wilson, W. H. (2013). "Treatment strategies for aggressive lymphomas: what works?" Hematology 2013(1): 584-590.

Localised disease (stage I and selected stage II) – Patients with only one lymph node group or two adjacent groups are most commonly treated with 3-4 cycles of immuno-chemotherapy (e.g. R-CHOP) followed by involved field radiotherapy. For selected patients in whom radiotherapy may be problematic (e.g. young woman where the radiotherapy field would involve the breast) a complete course of immuno-chemotherapy (e.g. 6 cycles of R-CHOP) may be preferable. For bulky localised disease, consider a full course of chemotherapy plus radiotherapy.

Advanced disease (stage III and IV) – The current standard of care is 6-8 cycles of R-CHOP with consideration of radiotherapy to sites of original bulky disease at the end of treatment. Modifications may be required for the elderly and patients with cardiac disease (e.g. R-CNOP or R-CEOP). CNS directed therapy is required for at risk patients (risk factors include involvement of testes, epidural space, sinuses, bulk, and high IPI). Patients with Burkitt’s or lymphoblastic lymphoma are treated according to the relevant trial protocols.

Double hit lymphoma Patients with FISH-demonstrated rearrangements of c-myc and either bcl-2, bcl-6, or both, have a poor outcome with conventional R-CHOP chemotherapy. The current standard of care for fitter patients is the R-DA-EPOCH regimen. See Reagan, P. M. and A. Davies (2017). "Current treatment of double hit and double expressor lymphoma." Hematology Am Soc Hematol Educ Program 2017(1): 295-297.

About this Canterbury DHB document (5959):

Document Owner:

Peter Ganly (see Who's Who)

Issue Date:

November 2018

Next Review:

November 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5959