Approach to DLBCL Treatment

Previously untreated patients

  • DLBCL is not a single entity but a variety of clinicopathologic syndromes7,9
  • Current research focuses on improving clinical outcomes for the 40% of patients who die within 5 years of diagnosis3
  • Improvements in risk stratification may also help transition toward a more personalized approach to patient monitoring. Patients with a particularly high risk of disease progression following treatment may be monitored more closely21-23

Relapsed/refractory patients

  • Patients who relapse, or have partial response or progressive disease during treatment, move on to the next line of therapy12
  • Patients who are candidates for high-dose therapy (HDT) and respond to a second-line chemotherapy regimen may undergo any of the following12:
    • HDT followed by autologous stem cell rescue (with or without involved field radiation therapy)
    • Allogeneic stem cell transplant in selected cases (eg, mobilization failures, persistent bone marrow involvement)
  • Patients who are not candidates for HDT may be eligible for additional second-line therapies or palliative therapies24
  • New prognostic and predictive molecular markers for outcomes in the second-line setting are current areas of research23

Patients with transformation to DLBCL

  • Follicular lymphoma generally has a long relapsing/remitting disease course, but in some cases can behave aggressively25,26
  • In patients with progressive disease, fluorodeoxyglucose-positron emission tomography (FDG-PET) may indicate transformation and directed biopsy at the most FDG-avid area should be performed.12 The approximate frequency of histologic transformation of FL into aggressive disease ranges from 10% to 60%26
    • The reported range of transformation is 15%-30% at 5 years and 28%-56% at 10 years, suggesting a cumulative rate of transformation of 3% per year26
  • Transformation of follicular lymphoma to an aggressive lymphoma subtype is associated with a fast-moving progressive clinical course, refractoriness to treatment, and short survival26
    • Treatment options for patients with confirmed histologic transformation to DLBCL depend on the disease stage and the number of prior therapies12
    • The median overall survival for these patients has ranged from 2.5 to 22 months26,27