Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Aug 17;9(64):32383-32399.
doi: 10.18632/oncotarget.25892.

Spanish Lymphoma Group (GELTAMO) guidelines for the diagnosis, staging, treatment, and follow-up of diffuse large B-cell lymphoma

Eva González-Barca  1 , Mónica Coronado  2 , Alejandro Martín  3 , Carlos Montalbán  4 , Santiago Montes-Moreno  5 , Carlos Panizo  6 , Guillermo Rodríguez  7 , Juan Manuel Sancho  8 , Andrés López-Hernández  9 ; Spanish Lymphoma Group (GELTAMO)
Affiliations
Review

Spanish Lymphoma Group (GELTAMO) guidelines for the diagnosis, staging, treatment, and follow-up of diffuse large B-cell lymphoma

Eva González-Barca et al. Oncotarget. .

Abstract

Diffuse large B-cell lymphoma (DLBCL) accounts for approximately 30% of non-Hodgkin lymphoma (NHL) cases in adult series. DLBCL is characterized by marked clinical and biological heterogeneity, encompassing up to 16 distinct clinicopathological entities. While current treatments are effective in 60% to 70% of patients, those who are resistant to treatment continue to die from this disease. An expert panel performed a systematic review of all data on the diagnosis, prognosis, and treatment of DLBCL published in PubMed, EMBASE and MEDLINE up to December 2017. Recommendations were classified in accordance with the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework, and the proposed recommendations incorporated into practical algorithms. Initial discussions between experts began in March 2016, and a final consensus was reached in November 2017. The final document was reviewed by all authors in February 2018 and by the Scientific Committee of the Spanish Lymphoma Group GELTAMO.

Keywords: DLBCL; DLBCL entities; guidelines; risk assessment; treatment.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST EGB has received honoraria as speaker from Roche and has served as a consultant to and received compensation from Servier, Sanofi, Gilead, and Janssen. MC declares that she has no relevant or material financial interests that relate to the research described in this paper. AM has received honoraria as a speaker from Celgene, Janssen, Roche, and Servier, honoraria for participating in advisory boards from Gilead, Celgene, Servier, and Roche, and research support from Janssen. CM has received honoraria as a speaker from Takeda. SMM has served as a consultant to and has received compensation from Roche and Takeda. CP has received honoraria as a speaker from Takeda, Janssen, and Roche and has served as a consultant to and received compensation from Servier, Takeda, and Janssen. GR has received honoraria as a speaker from Roche, Takeda, Janssen, Celgene, and Servier and has received honoraria for participation in advisory boards from Janssen, Celgene, and BMS. JMS has received honoraria as a speaker from Roche, Gilead, Celgene, Janssen, and Mundipharma, honoraria for participation in advisory boards from Roche, Gilead, Janssen, Sanofi, and Servier, and research support from Teva. AL has received honoraria as a speaker from Servier, Janssen, Gilead, Celgene, and Takeda, honoraria for participation in advisory boards from Gilead, Takeda, and Servier, and research support from Roche. There are no other potential conflicts of interest relevant to this paper to be declared.

Figures

Figure 1
Figure 1. Histopathological diagnosis of DLBCL
Tissue biopsy. (‡) Other entities: [T cell/histiocyte-rich large B-cell lymphoma, primary CNS large B-cell lymphoma, primary “leg type” large B-cell lymphoma, EBV-positive large B-cell lymphoma-NOS, DLBCL associated with chronic inflammation, lymphomatoid granulomatosis, primary mediastinal large B-cell lymphoma (thymic), Intravascular large B-cell lymphoma, Burkitt-like lymphoma with 11q aberration, B-cell lymphoma, Unclassifiable, with features intermediate between Hodgkin´s lymphoma and DLBCL (grey zone B-cell lymphoma), large B-cell lymphoma with IRF4 rearrangement]. DLBCL: large B-cell lymphoma; NOS: Not otherwise specified.
Figure 2
Figure 2. First line therapy
*Risk factors: High LDH level, Ann Arbor stage II, ECOG PS > 0, Age > 60 years. DLBCL: large B cell lymphoma; IFRT: involved-field radiation therapy; IPI: international prognostic index; R-CHOP: rituximab, cyclophosphamide, daunorubicin (doxorubicin), vincristine, prednisone; R-COMP: rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone; RCOP: rituximab, cyclophosphamide, vincristine, prednisone.
Figure 3
Figure 3. Salvage therapy
BEAM: carmustine, etoposide, cytarabine, melphalan; HSCT: hematopoietic stem cell transplantation; R-DHAP: rituximab, dexamethasone, cytarabine, cisplatin; R-ESHAP: rituximab, etoposide, methylprednisolone; cytarabine; cisplatin; R-GDP: rituximab, gemcitabine, cisplatin, dexamethasone; R-ICE: rituximab, ifosfamide, carboplatin, etoposide.
Figure 4
Figure 4. Treatment for special DLBCL subtypes
CNS: central nervous system; DA-EPOCH-R: dose-adjusted, etoposide, prednisone, vincristine, cyclophosphamide, daunorubicin (doxorubicin), rituximab; EBV: Epstein-Barr virus; G-CSF: granulocyte colony stimulating factor; PTLD: post-transplant lymphoproliferative disorder; R-CHOP: rituximab, cyclophosphamide, daunorubicin (doxorubicin), vincristine, prednisone.
See this image and copyright information in PMC

References

    1. Montes-Moreno S, Mollejo Villanueva M, Fraga M, García JF, Villar JL, Martínez A, Rodríguez Pinilla SM, Battle A, Pulla MP, Rozman M, García Sanz R. Recomendaciones para el estudio histopatológico, inmunohistoquímico, citogenético y molecular e informe diagnóstico de los procesos neoplásicos linfoides. Consenso SEAP-SEHH-GOTEL. En: Libro Blanco de la Anatomía Patológica en España. 2017. pp. 63–174. Available at: https://www.seap.es/libros-blancos.
    1. Alizadeh AA, Eisen MB, Davis RE, Ma C, Lossos IS, Rosenwald A, Boldrick JC, Sabet H, Tran T, Yu X, Powell JI, Yang L, Marti GE, et al. Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature. 2000;403:503–11. - PubMed
    1. Hans CP, Weisenburger DD, Greiner TC, Gascoyne RD, Delabie J, Ott G, Müller-Hermelink HK, Campo E, Braziel RM, Jaffe ES, Pan Z, Farinha P, Smith LM, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood. 2004;103:275–82. - PubMed
    1. Choi WW, Weisenburger DD, Greiner TC, Piris MA, Banham AH, Delabie J, Braziel RM, Geng H, Iqbal J, Lenz G, Vose JM, Hans CP, Fu K, et al. A New Immunostain Algorithm Classifies Diffuse Large B-Cell Lymphoma into Molecular Subtypes with High Accuracy. Clin Cancer Res. 2009;15:5494–502. - PMC - PubMed
    1. Johnson NA, Slack GW, Savage KJ, Connors JM, Ben-Neriah S, Rogic S, Scott DW, Tan KL, Steidl C, Sehn LH, Chan WC, Iqbal J, Meyer PN, et al. Concurrent Expression of MYC and BCL2 in Diffuse Large B-Cell Lymphoma Treated With Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. J Clin Oncol. 2012;30:3452–9. - PMC - PubMed