How I treat diffuse large B-cell lymphoma

Abstract

Diffuse large B-cell lymphoma (DLBCL) is usually treated with chemoimmunotherapy in curative intention at initial diagnosis. Novel agents have improved the prognosis of high-risk patients in the front-line and relapsed setting and more accurate prognostic tools enable less intensive treatment for low-risk patients, while maintaining their good prognosis. Here, we summarize our approach to DLBCL patients in the first-line setting according to their risk profile and other common challenges in clinical practice. We recommend an abbreviated course of chemoimmunotherapy in low-risk patients and a negative interim positron emission tomography. For patients with higher-risk disease, a new combination treatment with polatuzumab vedotin has been approved and is a new option in these patients. We also discuss our approach to patients with high risk for subsequent central nervous system involvement, with leg-type lymphoma or with severe comorbidities.

Keywords: CAR-T cells; diffuse large B-cell lymphoma; interim PET; polatuzumab vedotin.

Figure 1

My approach to DLBCL outside a clinical trial. CAR-T, chimeric antigen receptor T cell; DHL, double-hit lymphoma; DLBCL, diffuse large B-cell lymphoma; iPET, interim positron emission tomography; IPI, international prognostic index; LDH, lactate dehydrogenase; POLA-R-CHP, polatuzumab, vedotin, rituximab, cyclophosphamide, doxorubicin and prednisone; R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone; R-DA-EPOCH, rituximab-dose-adjusted, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin; TH, triple-hit.