Canterbury DHB


Diffuse Large B-Cell Lymphoma (DLBCL)

In This Section



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.

Poeschel V, Held G, Ziepert M, et al. Four versus six cycles of CHOP chemotherapy in combination with six applications of rituximab in patients with aggressive B-cell lymphoma with favourable prognosis (FLYER): a randomised, phase 3, non-inferiority trial. Lancet 2020;394(10216):2271-2281. DOI: 10.1016/S0140-6736(19)33008-9.

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.

Further reading

Sehn LH, Salles G. Diffuse Large B-Cell Lymphoma. New England Journal of Medicine 2021;384(9):842-858. DOI: 10.1056/nejmra2027612.

About this Canterbury DHB document (5959):

Document Owner:

Peter Ganly (see Who's Who)

Last Reviewed:

December 2021

Next Review:

December 2024


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

Topic Code: 5959