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Diffuse large b cell lymphoma treatment

Diffuse large b cell lymphoma treatment





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A cancer of the lymphatic system, which is a part of the body’s immune system, non-Hodgkin’s lymphoma (NHL) also is referred to as non-Hodgkin lymphoma or lymphoma. Anaplastic Large Cell Lymphoma; large number of patients with this form of lymphoma. The most widely used treatment for DLBCL • Diffuse Large B-Cell Lymphoma. Nov 27, · Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in all countries and all.
References National Cancer Institute. There is still no proof that surveillance imaging benefits patients with diffuse large B-cell lymphoma Diffuse followed up in remission. The radioactive monoclonal Cell ibritumomab Zevalin is also an option for initial treatment, although this is more often used as a second-line treatment. For more advanced Treatment MALT lymphomas, which are rare, treatment is often Lymphoma to that for follicular lymphoma see above. Learn about your treatment options and seek out family and friends for support. If you log out, you will be required to enter your username and password the next time you visit. The WHO classification of Large
A cancer of the lymphatic system, which is a part of the body’s immune system, non-Hodgkin’s lymphoma (NHL) also is referred to as non-Hodgkin lymphoma or lymphoma. Anaplastic Large Cell Lymphoma; large number of patients with this form of lymphoma. The most widely used treatment for DLBCL • Diffuse Large B-Cell Lymphoma. Nov 27, · Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in all countries and all.

diffuse large b cell lymphoma treatment

diffuse large b cell lymphoma treatment

diffuse large b cell lymphoma treatment

diffuse large b cell lymphoma treatment

diffuse large b cell lymphoma treatment

diffuse large b cell lymphoma treatment

diffuse large b cell lymphoma treatment

diffuse large b cell lymphoma treatment

Large cell diffuse lymphoma treatment b mobile model

If it is not causing symptoms, it is often watched closely without treating it right away. The disorder is an angiocentric and angiodestructive process that is known to evolve into diffuse large B-cell lymphoma in some cases. These findings have been confirmed in additional randomized trials [ 12 , 32 ]. The physical exam may reveal swollen lymph nodes in various locations figure 1. Surveillance computed tomography scans for patients with lymphoma: A small portion of follicular lymphomas, known as grade 3 lymphomas, tend to grow quickly, more like diffuse large B-cell lymphoma DLBCL.

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Treatment usually depends both on the type of lymphoma and the stage extent of the disease, but many other factors can be important as well. Most often, the treatment is chemotherapy chemo, usually with a regimen of 4 drugs known as CHOP cyclophosphamide, doxorubicin, vincristine, and prednisone, plus the monoclonal antibody rituximab Rituxan.

Because this regimen contains the drug doxorubicin, which can damage the heart, it may not be suitable for patients with heart problems, so other chemo regimens may be used instead. For DLBCL that is only in 1 or 2 lymph node groups on the same side of the diaphragm the thin muscle that separates the chest from the abdomen, R-CHOP is often given for 3 to 6 cycles, which might be followed by radiation therapy to the affected lymph node areas.

People who have a higher risk of the lymphoma coming back later in the tissues around the brain and spinal cord may be treated with chemo injected into the spinal fluid called intrathecal chemotherapy.

Another option is to give high doses of methotrexate intravenously. This drug can pass into the spinal fluid. For younger patients with a higher risk of the lymphoma coming back based on the International Prognostic Index [IPI] score, high-dose chemo followed by a stem cell transplant might be an option.

Most doctors feel that if a transplant is done as part of the first treatment, it should be done in a clinical trial. Several different regimens can be used, and they may or may not include rituximab.

If the lymphoma shrinks with this treatment, it might be followed by a stem cell transplant if possible, as it offers the best chance of curing the lymphoma. Stem cell transplants are not effective unless the lymphoma responds to chemo.

Unfortunately, not everyone is healthy enough for a stem cell transplant. Clinical trials of new treatments may be another good option for some people. Patients with lower stages have better survival rates, as do patients with lower IPI scores.

This lymphoma, which starts in the space between the lungs the mediastinum, is treated like early stage diffuse large B-cell lymphoma. This may be followed by radiation to the mediastinum.

Often, the doctor will order a biopsy of the chest tumor to confirm that lymphoma is still present before starting radiation. This type of lymphoma often grows slowly and responds well to treatment, but it is very hard to cure.

It often comes back after treatment, although it can take many years to do so. Some people may never need treatment at all. For those who do, sometimes it might be years before treatment is needed.

If treatment is needed for follicular lymphoma that is only in 1 lymph node group or in 2 nearby groups that are both above or below the diaphragm the thin muscle separating the chest from the abdomen, the preferred treatment is radiation therapy to the lymph node areas affected by lymphoma called involved site radiation.

Other choices include treatment with rituximab Rituxan, chemo, or both, which might be followed by radiation therapy. If treatment is needed, the most common option is rituximab combined with chemo.

The chemo can be a single drug such as bendamustine or fludarabine or a combination of drugs, such as the CHOP cyclophosphamide, doxorubicin, vincristine, prednisone or CVP cyclophosphamide, vincristine, prednisone regimens.

If the lymphoma shrinks, a total of 6 cycles of chemo plus rituximab is usually given. Other options for initial treatment include rituximab alone or chemo alone either one or several drugs. If some lymph nodes are very large from the lymphoma, radiation may be used to reduce symptoms.

This is most often used for patients who are too sick to be treated with chemo. The radioactive monoclonal antibody ibritumomab Zevalin is also an option for initial treatment, although this is more often used as a second-line treatment.

For patients who may not be able to tolerate more intensive chemo regimens, rituximab alone, milder chemo drugs such as chlorambucil or cyclophosphamide, or both may be good options.

If the lymphoma shrinks or goes away with the initial treatment, doctors may advise either close follow-up or further treatment. This might include either rituximab for up to 2 years or treatment with ibritumomab.

Further treatment may lower the chance that the lymphoma will come back later and may help some patients live longer, but it can also have side effects.

If the lymphoma responds to this treatment, a stem cell transplant may be an option. A small portion of follicular lymphomas, known as grade 3 lymphomas, tend to grow quickly, more like diffuse large B-cell lymphoma DLBCL.

Small lymphocytic lymphoma SLL and chronic lymphocytic leukemia CLL are considered different versions of the same disease. The main difference is where the cancer cells are the blood and bone marrow for CLL, and the lymph nodes and spleen for SLL.

If treatment is needed, it depends on the stage. When the lymphoma is only in one lymph node or lymph node area stage I, it may be treated with radiation therapy alone.

For more advanced disease, the treatment is often the same as what is used for CLL. See Treating Chronic Lymphocytic Leukemia. Chemo, with or without rituximab or obinutuzumab Gazyva is one option for first-line treatment.

Chlorambucil, fludarabine, or bendamustine are some of the chemo drugs that are used. The targeted drug ibrutinib Imbruvica is another option, as is rituximab alone without chemo.

Because current treatments for this type of lymphoma are very unlikely to cure it, patients might want to consider taking part in a clinical trial. If the lymphoma has only spread to 1 lymph node group or to 2 nearby groups on the same side of the diaphragm stage I and some stage II, which is rare, it can sometimes be treated with radiation therapy.

Another option is to treat with chemo plus rituximab. However, since the introduction of rituximab the survival in all IPI groupings has improved. See Glossary of Chemotherapy Regimens for explanation of abbreviations used in this article.

Whether or not these more complicated regimens provide benefit to all patients with diffuse large B-cell lymphoma, I believe that certain patients should receive these regimens today ie, as discussed later in the article.

I do restaging after 4 cycles and if necessary again at 6 cycles, with a goal of treating 2 cycles after documenting remission. For those with localized lymphoma, I administer either 6 cycles of CHOP-R 4 if no disease remains after surgery or 4 cycles and involved-field radiotherapy.

One of the most serious complications for a patient with diffuse large B-cell lymphoma who presents with disease outside the central nervous system CNS is the development of CNS metastasis. This usually involves the cerebrospinal fluid and meninges, but solid parenchymal brain metastasis can also occur.

The latter seems more frequent with lymphoma originating in certain extranodal sites such as the testes. For that reason, patients thought to be at high risk for developing CNS involvement typically receive prophylactic therapy to attempt to reduce its frequency.

The most common treatment used to prevent meningeal metastasis has been intrathecal methotrexate plus or minus cytarabine with or without additional intravenous high-dose methotrexate. It is clear that most patients with diffuse large B-cell lymphoma are at a low risk of CNS metastasis.

For patients whose CNS metastasis is destined to appear coincident with systemic relapse, the value of prophylaxis might be marginal. Factors reported to be associated with CNS relapse include specific sites of involvement ie, nasopharyngeal, epidural, testicular, and other extranodal sites such as breast, adrenal gland, bone, and bone marrow, high serum lactate dehydrogenase, low serum albumin, age younger than 60 years, and more extensive disease.

It has been, and remains, my practice to recommend CNS prophylaxis using intrathecal methotrexate given with each cycle of CHOP-R to patients who present with epidural involvement, nasopharyngeal involvement, testicular involvement, and involvement of the bone marrow by large cell lymphoma ie, in most cases, bone marrow involvement in diffuse large B-cell lymphoma is by small cleaved cells 23, I consider, and might recommend, prophylactic therapy in patients with unusual extranodal sites such as adrenal gland, kidney, and bone.

It appears that some patients destined to develop meningeal metastasis from diffuse large B-cell lymphoma have cells present in the spinal fluid at diagnosis that can be detected by flow cytometry.

Controversy continues regarding the place of radiotherapy in the management of patients with diffuse large B-cell lymphoma who have sites of bulky disease at presentation. The definition of bulky disease has varied from 5 to 10 cm in different reports.

Some physicians believe that a patient who achieves a complete remission with a rituximab-containing regimen, particularly if defined by negative results on a positron emission tomographic PET scan, does not require consolidative radiotherapy to sites of bulky disease.

Long follow-up of patients from the MabThera International Trial suggested there still might be a place for radiotherapy after treatment including rituximab for those with bulky disease.

This trial compared 6 cycles of a CHOP-like regimen with the same regimen plus rituximab 28 in younger patients with diffuse large B-cell lymphoma that had a good prognosis.

Patients received radiotherapy to sites of initially bulky disease after the completion of chemotherapy. Radiotherapy seemed to eliminate the anticipated negative prognostic impact of bulky disease.

An equivocal PET scan result at the completion of treatment would make me more likely to administer the radiotherapy. Autologous hematopoietic stem cell transplant remains the best treatment for patients with chemotherapy-sensitive relapse.

The place of autologous hematopoietic stem cell transplant after relapse following a rituximab-containing regimen has been questioned. Whether an autotransplant should be offered to any patient who presents with very high-risk disease as an adjuvant after a remission induced with a rituximab-containing chemotherapy regimen remains problematic.

Allogeneic transplant has limited utility in the treatment of patients with diffuse large B-cell lymphoma. I always favor autologous transplant as part of the treatment for an initial relapse.

I have occasionally recommended allogeneic transplant to a young, fit patient who has failed autologous transplant and has an HLA-matched sibling donor. There is still no proof that surveillance imaging benefits patients with diffuse large B-cell lymphoma being followed up in remission.

In fact, there is some evidence that it can be detrimental, 38 and it adds to the cost of care. My personal approach continues to be to see patients at 2-month intervals in the first year of follow-up, 3-month intervals for the second year, 4-month intervals for the third year, 6-month intervals for 2 years, and then once a year indefinitely.

I believe seeing patients more frequently shortly after treatment allows the physician to help them during a time of particular anxiety and that extending the time between visits in a regular way helps them feel confident that things are going well.

Each visit consists of a thorough history and physical examination and routine laboratory studies. Imaging studies and appropriate biopsies are performed only when a new finding raises a question of relapse.

I have a few patients whose friends or neighbors receive routine images and wonder if they might benefit from them. Most patients are satisfied by a discussion about the potential benefits and risks of routine images in remission.

However, if the patient wants the images, I am willing to do them. Perhaps the most important issue in caring for patients with diffuse large B-cell lymphoma in remission is never to initiate treatment for relapse in the absence of a biopsy that proves relapse.

In the past few years we have had patients in whom we considered starting therapy for what seemed obvious relapse who, on biopsy, had histoplasmosis, coccidiomycosis, and sarcoidosis.

Patients who achieve a complete remission and might be cured should never be treated for relapse without proving recurrence of their lymphoma. When fluorodeoxyglucose PET hereafter referred to as PET scans were first introduced into the care of patients with lymphoma, it was quickly apparent that they had great potential to influence care.

Diffuse large B-cell lymphoma is one of the most consistently PET-avid lymphomas. It has become clear that PET scans are more accurate than CT scans in proving complete remission and that a negative PET scan result has the greatest impact in predicting progression-free and overall survival.

I try to have a PET scan performed as part of staging in all patients with diffuse large B-cell lymphoma. Achieving a negative PET scan result is the criterion I use for documenting complete remission.

However, a borderline-positive PET scan at the completion of therapy does not necessarily mean persistent disease. In patients with localized disease, radiotherapy is often administered in this setting.

In patients with disseminated disease, either performing a biopsy or waiting for 1 to 2 months and repeating the scan to see if results have normalized is a reasonable approach. One of the new topics in applying PET scans to the treatment of patients with diffuse large B-cell lymphoma is the use of early, or interim, scans to predict treatment outcome after only 1 to 3 cycles of treatment.

Some studies, 50,51 but not all, 52,53 have found a dramatic impact on eventual treatment outcome. At the present time I do not use PET scans after 2 or 3 cycles of treatment to direct therapy.

However, it is possible that this will become the standard treatment approach in the future. Although surveillance PET scans in patients with diffuse large B-cell lymphoma in remission are not specific and should not be routinely performed, in patients in whom relapse is suspected, PET scans can be extremely useful in identifying the best site to biopsy.

Unfortunately, many insurance companies will not authorize a PET scan in this setting. Patients with congestive heart failure who develop diffuse large B-cell lymphoma present a difficult problem.

Doxorubicin, the most active traditional chemotherapeutic agent in diffuse large B-cell lymphoma, is associated with a significant risk of worsening of the heart failure, and most physicians believe it would be contraindicated.

A number of approaches have been proposed to treat these patients. These include deleting doxorubicin from CHOP-R, substituting mitoxantrone for doxorubicin, substituting liposome-encapsulated doxorubicin, 55 substituting etoposide for doxorubicin, using bendamustine-R, 56 and substituting procarbazine for doxorubicin.

The approach that I have adopted was recently reported by the Vancouver group. These patients were matched 2: The version of the World Health Organization WHO classification of lymphoid malignancies recognizes numerous subtypes of diffuse large B-cell lymphoma.

In addition, there are tumors that exist on the interface between diffuse large B-cell lymphoma and Burkitt lymphoma and between mediastinal large B-cell lymphoma and Hodgkin lymphoma, other rare clinical presentations such as leukemic diffuse large B-cell lymphoma, double-hit diffuse large B-cell lymphomas, and those with a very high proliferative rate—often with an MYC translocation.

As we become more sophisticated at subdividing patients with diffuse large B-cell lymphoma, it would seem reasonable to suspect that biologically unique entities might be identified that would require special treatment approaches.

It is increasingly clear that this is, in fact, the case. I will deal here with those groups in which I believe modification of the therapeutic approach is appropriate Table 3. Plasmablastic lymphoma is a diffuse proliferation of large cells that resemble immunoblasts but have the immunophenotype of plasma cells.

This lymphoma was originally thought to be seen predominantly in individuals positive for the human immunodeficiency virus HIV, with presentation involving the oral cavity.

However, it is now clear that this lymphoma can also occur in patients who are not infected with HIV and have other, although predominantly extranodal, presenting sites. Therapy with rituximab will not benefit these patients, and it should not be used unless the patient has one of the rare plasmablastic lymphomas that is CDpositive.

It is possible that combining drugs such as bortezomib with CHOP, or performing autotransplants in remission for those patients who achieve a complete remission, might improve the treatment outcome.

Clean amp lymphoma treatment large diffuse b cell days week

CT, or computed tomography. Lumbar puncture or spinal tap. The doctor will look for lymphoma cells in the fluid around your spinal cord. This test uses radioactive material to look for signs of cancer.

These tests help the doctor determine the stage of the cancer and how far it has spread. Whether your disease is found early or later, the treatment is usually the same. The goal is to destroy the cancer cells and leave healthy cells alone.

The “R” stands for rituximab. You get this treatment by IV and as a pill. You may also need radiation. This treatment uses X-rays to destroy your cancer cells.

Some people get a fifth chemotherapy drug, called etoposide Vepesid. The chance of it coming back is linked to your age, general health, the stage of your illness, and where it is on your body.

If it does return, your doctor may suggest a treatment that combines high-dose chemotherapy with a stem cell transplant. The stem cells in a stem cell transplant are different. These are cells that can come from your blood or bone marrow or from umbilical cord blood and help make new blood cells.

First, your doctor will give you a drug called a “growth factor” that causes your stem cells to move from your bone marrow to your bloodstream. Your doctor collects the stem cells from your blood.

Sometimes the stem cells are frozen so they can be used later. After the collection of your stem cells from your blood, you will get treated with high doses of chemotherapy or radiation that could last for several days.

This can be a tough process because you may get side effects such as mouth and throat sores or nausea and vomiting. You can take medication that eases some of these side effects.

A few days after your chemotherapy is over, you may be ready to begin your stem cell transplant. The stem cells are given to you through an IV. It can take 8 to 14 days after the transplant for your bone marrow to start producing new blood cells.

You may need to stay in the hospital for a few weeks. During this time you may also be at risk for infection while your bone marrow gets back to normal, so your doctor may give you antibiotics to keep you from getting sick.

You may still be at a higher risk for infection for several months after you get home from the hospital. Your family and friends can be a great source of support. It always helps to share your worries and fears with other people.

These trials test new drugs to see if they are safe and if they work. Your doctor can tell you if one of these trials might be good for you. Your energy and emotions may go up and down as you go through it.

Talk about your fears and feelings with your loved ones. Ask your doctor about finding a cancer support group. Let them know how they can help. The Lymphoma Research Foundation has many resources on treatment options, advances in research, clinical trials, and ways to cope with lymphoma.

These include one-on-one peer support and financial aid programs. They do know that you are more likely to get them if: You are middle-aged or older. You are a man. You are not Asian or African-American.

You may also have: However, it is now clear that this lymphoma can also occur in patients who are not infected with HIV and have other, although predominantly extranodal, presenting sites.

Therapy with rituximab will not benefit these patients, and it should not be used unless the patient has one of the rare plasmablastic lymphomas that is CDpositive. It is possible that combining drugs such as bortezomib with CHOP, or performing autotransplants in remission for those patients who achieve a complete remission, might improve the treatment outcome.

Lymphomatoid granulomatosis is an Epstein-Barr virus—positive B-cell lymphoproliferative disorder that usually arises in patients with no history of immunodeficiency. The condition is a progressive immune disorder that involves the lung and other organs such as the CNS, skin, liver, and kidney.

The disorder is an angiocentric and angiodestructive process that is known to evolve into diffuse large B-cell lymphoma in some cases. Grade 3 lymphomatoid granulomatosis is often monoclonal and often evolves into, and behaves like, diffuse large B-cell lymphoma.

Patients with low-grade lymphomatoid granulomatosis can be effectively managed with interferon or rituximab, and some patients can have durable responses. Investigators at the US National Cancer Institute have utilized EPOCH-R for patients with high-grade or transformed lymphomatoid granulomatosis and for patients with low-grade disease in whom interferon therapy failed and have found a high overall survival.

My approach is to treat patients whose disease is transforming to diffuse large B-cell lymphoma with CHOP-R, and I have treated patients with lower-grade disease with rituximab.

It is important to realize that some patients who present with diffuse large B-cell lymphoma arising in lymphomatoid granulomatosis and achieve a remission will relapse with lower-grade lymphomatoid granulomatosis.

I have one such patient who underwent salvage treatment with rituximab and has had a durable remission. Diffuse large B-cell lymphoma presenting as a brain tumor, with or without meningeal or ocular involvement, is being seen increasingly in HIV-negative patients.

Therapy with CHOP-R or with primary radiotherapy has a poor outcome, with a median survival of less than 1 year. This is a particularly serious problem in patients who are treated after 60 years of age.

However, in patients in whom primary chemotherapy regimens fail, radiotherapy provides an important palliative option. Diffuse large B-cell lymphoma is the most common testicular tumor in men older than 60 years.

It has been known for some time that this lymphoma follows an atypical clinical course. Patients often have recurrent disease in the opposite testicle if they do not receive scrotal radiotherapy, and CNS metastases ie, sometimes parenchymal masses occur frequently.

Of course, these patients remain at risk for late relapse. At the present time I believe this is the best treatment approach for patients with primary testicular lymphoma and the one that I offer to my patients.

Patients with cutaneous B-cell lymphomas who are diagnosed as having diffuse large B-cell lymphoma might fit into 1 of 2 categories. Primary cutaneous diffuse large B-cell lymphoma, leg type, typically presents on the lower legs of elderly women.

I have seen other patients with cutaneous B-cell lymphoma, often presenting on the scalp and often in younger patients, diagnosed as diffuse large B-cell lymphoma. These tumors probably belong in the WHO category primary cutaneous follicle center cell lymphoma.

Because the treatment and prognosis vary so widely, it is important to make every effort to distinguish between these 2 entities. Intravascular and leukemic diffuse large B-cell lymphoma represent 2 other variants.

Both are rare presentations of diffuse large B-cell lymphoma. Only the intravascular large B-cell lymphoma has a category in the WHO classification. The tumors grow in association with endothelial cells and can disrupt the function of any involved organ.

However, the last patient I saw presented with liver failure. In the absence of a high degree of suspicion, these patients might not be diagnosed until an autopsy.

In fact, they are often subjects of clinicopathologic conferences. There is also an Asian variant that typically presents with hepatosplenomegaly, pancytopenia, and hemophagocytic syndrome.

Patients with intravascular diffuse large B-cell lymphoma usually respond to CHOP-R or similar regimens and can have long-term, disease-free survival if they achieve a complete remission.

Patients with diffuse large B-cell lymphoma that presents with leukemia ie, circulating large lymphoma cells have been thought to have a terrible prognosis. However, a recent series of patients treated at Emory University and the University of Nebraska showed that these patients can achieve a complete remission when treated with rituximab-containing regimens and that these remissions can be durable.

A number of subgroups of diffuse large B-cell lymphoma fit under this heading. There is considerable overlap among these groups. It does appear clear that, when treated with CHOP-R—like regimens, patients with double-hit diffuse large B-cell lymphoma have a very poor prognosis, with reported survival ranging from 4 to 25 months and the poorest survival in the largest series.

Patients with lymphomas intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma have been reported to have a poorer outcome than those with typical diffuse large B-cell lymphoma, but these patients often have adverse genetic abnormalities, including double hits.

My approach for patients with double-hit lymphomas, tumors that are identified as being at the interface between diffuse large B-cell and Burkitt lymphoma, and tumors that are MYC – positive is to use EPOCH-R.

The infusional regimen has been shown to have a high cure rate in patients with Burkitt lymphoma 81 and to be at least as effective as CHOP-R in patients with typical diffuse large B-cell lymphoma.

I consider performing an autotransplant in first remission, particularly in patients with double-hit lymphomas. These lymphomas are at the interface between mediastinal diffuse large B-cell lymphoma and classic Hodgkin lymphoma.

They display both morphological and immunophenotypic features typically found in nodular sclerosing Hodgkin lymphoma and mediastinal large B-cell lymphoma. Interestingly, a recent report from investigators at the National Cancer Institute suggested that patients with mediastinal gray zone lymphoma had a much poorer outcome when treated with EPOCH-R than similar patients with typical mediastinal large B-cell lymphoma.

This treatment can be curative. Whether these patients would be better treated with Hodgkin lymphoma—like regimens, have autotransplants as part of their primary therapy, 84 or have entirely different treatment approaches needs to be resolved.

We have known for some time that patients with the activated B-cell ABC genetic subtype of diffuse large B-cell lymphoma have a poorer outcome than those with the germinal center B-cell subtype.

This is leading to prospective trials of bortezomib-containing combination chemotherapy regimens in patients with ABC-type diffuse large B-cell lymphoma. A subset of patients with diffuse large B-cell lymphoma overexpresses the protein CD30, which is typically found in anaplastic large-cell lymphoma, albeit at a lower concentration than seen in anaplastic large-cell lymphoma.

In addition, a subset of patients with diffuse large B-cell lymphoma overexpresses the protein anaplastic lymphoma kinase ALK. It has become clear that the entity we call diffuse large B-cell lymphoma is made up of a variety of clinicopathologic syndromes that should not all have identical treatment.

As we better understand the biological explanation for these differences eg, site of involvement, proliferative rate, we might develop more specific and more effective therapies. In the meantime, trying to optimize use of currently available tools eg, PET scans, chemotherapeutic agents, radiotherapy through clinical studies will increase our ability to benefit patients with diffuse large B-cell lymphoma.

This remains a work in progress, but patients have gained much by the work done to date. National Center for Biotechnology Information, U. Journal List Mayo Clin Proc v. Address to James O.

This article has been cited by other articles in PMC. Abstract My favored treatment approach for patients with diffuse large B-cell lymphoma continues to evolve. What Has Not Changed? Approach to the Patient Diffuse large B-cell lymphoma is a potentially fatal but also a potentially curable illness.

Diagnosis The most important step in the treatment of patients with this lymphoma continues to be an accurate diagnosis. Central Nervous System Prophylaxis One of the most serious complications for a patient with diffuse large B-cell lymphoma who presents with disease outside the central nervous system CNS is the development of CNS metastasis.

The Use of Radiotherapy Controversy continues regarding the place of radiotherapy in the management of patients with diffuse large B-cell lymphoma who have sites of bulky disease at presentation.

The Place of Transplantation Autologous hematopoietic stem cell transplant remains the best treatment for patients with chemotherapy-sensitive relapse. Surveillance Imaging in Remission There is still no proof that surveillance imaging benefits patients with diffuse large B-cell lymphoma being followed up in remission.

The Diagnosis of Relapse Perhaps the most important issue in caring for patients with diffuse large B-cell lymphoma in remission is never to initiate treatment for relapse in the absence of a biopsy that proves relapse.

Increasing Importance of PET Scans When fluorodeoxyglucose PET hereafter referred to as PET scans were first introduced into the care of patients with lymphoma, it was quickly apparent that they had great potential to influence care.

Patients With Heart Disease Patients with congestive heart failure who develop diffuse large B-cell lymphoma present a difficult problem. Morphologic Variants Requiring Treatment Modification Plasmablastic lymphoma is a diffuse proliferation of large cells that resemble immunoblasts but have the immunophenotype of plasma cells.

Specific Anatomic Sites That Require Treatment Modification Diffuse large B-cell lymphoma presenting as a brain tumor, with or without meningeal or ocular involvement, is being seen increasingly in HIV-negative patients.

Mediastinal Gray Zone Lymphoma These lymphomas are at the interface between mediastinal diffuse large B-cell lymphoma and classic Hodgkin lymphoma. Conclusion It has become clear that the entity we call diffuse large B-cell lymphoma is made up of a variety of clinicopathologic syndromes that should not all have identical treatment.

Footnotes Potential Competing Interests: Combination sequential chemotherapy in advanced reticulum cell sarcoma. Advanced diffuse histiocytic lymphoma, a potentially curable disease.

How I treat patients with diffuse large B-cell lymphoma. N Engl J Med. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis normal LDH aggressive lymphomas: Testicular lymphoma is associated with a high incidence of extranodal recurrence.

Brain parenchyma involvement as isolated central nervous system relapse of systemic non-Hodgkin lymphoma: Diffuse large B-cell lymphoma with involvement of the kidney: Biol Blood Marrow Transplant.

Systemic and intrathecal chemotherapy followed by high-dose chemotherapy with autologous stem cell aggressive lymphomas; a potentially curative approach? The role of intrathecal chemotherapy prophylaxis in patients with diffuse large B-cell lymphoma.

Incidence and risk factors for central nervous system relapse in patients with diffuse large B-cell lymphoma: Hematol Oncol Clin North Am. Impact of concordant and discordant bone marrow involvement on outcome in diffuse large B-cell lymphoma treated with R-CHOP.

High incidence of occult leptomeningeal disease detected by flow cytometry in newly diagnosed aggressive B-cell lymphomas at risk for central nervous system involvement: Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy.

The impact of radiation therapy in patients with diffuse large B-cell lymphoma with positive post-chemotherapy FDG-PET or gallium scans. Autologous stem cell transplantation remains beneficial for patients relapsing after R-CHOP and who respond to salvage chemotherapy.

Randomized phase III U. A comparison of HLA-identical sibling allogeneic versus autologous transplantation for diffuse large B cell lymphoma: Low nonrelapse mortality and prolonged long-term survival after reduced-intensity allogeneic stem cell transplantation for relapsed or refractory diffuse large B cell lymphoma: Surveillance computed tomography scans for patients with lymphoma: Clin Lymphoma Myeloma Leuk.

Combined PET and low-dose, noncontrast CT scanning obviates the need for additional diagnostic contrast-enhanced CT scans in patients undergoing staging or restaging for lymphoma. Revised response criteria for malignant lymphoma.

Epratuzumab with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy in patients with previously untreated diffuse large B-cell lymphoma.

Phase II study of bendamustine in combination with rituximab as first-line treatment in patients 80 years or older with aggressive B-cell lymphomas. Association of lymphomatoid granulomatosis with Epstein-Barr viral infection of B lymphocytes and response to interferon-alpha 2b.

How I treat primary CNS lymphoma. Salvage radiotherapy in patients with recurrent or refractory primary or secondary central nervous system lymphoma after methotrexate-based chemotherapy.

Patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group.

The monoclonal antibody rituximab may be another option. For these early-stage gastric MALT lymphomas, treatment is usually either radiation therapy to the stomach or rituximab. For more advanced gastric MALT lymphomas, which are rare, treatment is often similar to that for follicular lymphoma see above.

Lymphomas that are not growing quickly may be watched and not treated right away. If the lymphoma is large, is causing symptoms, or is growing, it can be treated with radiation therapy to the stomach, rituximab, chemo, chemo plus rituximab, or the targeted drug ibrutinib Imbruvica.

The chemo drugs used are the same as those used for follicular lymphoma, and may include single agents such as chlorambucil or fludarabine or combinations such as CHOP cyclophosphamide, doxorubicin, vincristine, prednisone or CVP cyclophosphamide, vincristine, prednisone.

For MALT lymphomas that start in sites other than the stomach non-gastric lymphomas, treatment depends on the location of the lymphoma and how much it has spread. Early-stage lymphomas can often be treated with radiation to the area containing the lymphoma.

In certain sites such as the lungs, breast, or thyroid, surgery may be an option. If it does need treatment, it is usually treated the same way as follicular lymphoma which also tends to grow slowly.

If treatment is needed for lymphoma that is only in 1 lymph node group or in 2 nearby groups on the same side of the diaphragm the thin muscle separating the chest from the abdomen, the preferred treatment is radiation therapy to the lymph node areas affected by lymphoma called involved site radiation.

Other choices include treatment with rituximab Rituxan, chemo, or both, which might be followed by radiation therapy. The chemo can be a single chemo drug such as bendamustine or fludarabine or a combination of drugs, such as the CHOP cyclophosphamide, doxorubicin, vincristine, prednisone or CVP cyclophosphamide, vincristine, prednisone regimens.

The radioactive monoclonal antibody ibritumomab tiuxetan Zevalin is also an option for initial treatment, although this is more often used as a second treatment. For patients who may not be able to tolerate more intensive stronger chemo regimens, rituximab alone, milder chemo drugs such as chlorambucil or cyclophosphamide, or both may be good options.

This might include either rituximab for up to 2 years or treatment with ibritumomab tiuxetan. Nodal marginal zone B-cell lymphoma can also change into a fast-growing diffuse large B-cell lymphoma DLBCL, which would require more aggressive chemotherapy see above.

This is typically a slow-growing lymphoma. If it is not causing symptoms, it is often watched closely without treating it right away. About 1 in 3 people with this type of lymphoma have chronic hepatitis C virus HCV infection.

Treating the infection with anti-viral drugs can often cause these lymphomas to go into remission. This can be very helpful in relieving symptoms if the spleen is enlarged. Treatment with rituximab may be another option.

Another option might be the targeted drug ibrutinib Imbruvica. Sometimes this lymphoma can transform into an aggressive large-cell lymphoma, which then requires more intensive chemo. This is a very fast-growing lymphoma that is similar to a type of acute lymphocytic leukemia.

It is usually treated in the hospital with intensive chemo, which usually includes at least 5 chemo drugs. Rituximab may also be added. Some examples of chemo regimens used for this lymphoma include:.

Because this lymphoma tends to invade the area around the brain and spinal cord, the chemo drug methotrexate is often given into the spinal fluid called intrathecal therapy.

This may not be needed if high-dose methotrexate is given as a part of the main chemotherapy regimen. An important part of the initial treatment of this disease is making sure a person gets plenty of fluids, as well as drugs like allopurinol, to help prevent tumor lysis syndrome described in Chemotherapy for Non-Hodgkin Lymphoma.

If the lymphoma goes into remission, the doctor might suggest a stem cell transplant. The main treatment for this lymphoma is usually chemo or rituximab. For more detailed information see Treating Waldenstrom Macroglobulinemia.

This is a slow-growing lymphoma that tends to invade the spleen and lymph nodes as well as the blood. When treatment is needed, most often the chemo drugs cladribine 2-CdA or pentostatin are used.

For more detailed information, see Treating Chronic Lymphocytic Leukemia. This lymphoma begins in the brain or spinal cord. It often develops in older people or those with immune system problems caused by AIDS or drugs given to keep transplanted organs from being rejected.

For people in reasonably good health, high IV doses of the drug methotrexate have been shown to be the most effective treatment. This is given along with the drug leucovorin and IV fluids, which help limit serious side effects.

Other chemo drugs, such as cytarabine, may be added. Rituximab may be added as well. An issue with radiation therapy to the brain, especially in older patients, is that it can often cause mental changes.

Doctors limit the dose of radiation to try to lessen this problem. If CNS lymphoma keeps growing or comes back after treatment, further options may include chemo using different drugs, radiation therapy, or a stem cell transplant if the person is healthy enough.

Treatment of lymphoma of the eye primary intraocular lymphoma is discussed in Treating Eye Cancer. The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team.

It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options.

Principles and Practice of Oncology. Adult Non-Hodgkin Lymphoma Treatment. Practice Guidelines in Oncology: May 31, Last Revised: For reprint requests, please see our Content Usage Policy.

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Stage I or II For DLBCL that is only in 1 or 2 lymph node groups on the same side of the diaphragm the thin muscle that separates the chest from the abdomen, R-CHOP is often given for 3 to 6 cycles, which might be followed by radiation therapy to the affected lymph node areas.

Primary mediastinal B-cell lymphoma This lymphoma, which starts in the space between the lungs the mediastinum, is treated like early stage diffuse large B-cell lymphoma. Follicular lymphoma This type of lymphoma often grows slowly and responds well to treatment, but it is very hard to cure.

Stage I and early-stage II If treatment is needed for follicular lymphoma that is only in 1 lymph node group or in 2 nearby groups that are both above or below the diaphragm the thin muscle separating the chest from the abdomen, the preferred treatment is radiation therapy to the lymph node areas affected by lymphoma called involved site radiation.

Small lymphocytic lymphoma and chronic lymphocytic leukemia Small lymphocytic lymphoma SLL and chronic lymphocytic leukemia CLL are considered different versions of the same disease. When possible, the chemo treatment is intense, using regimens such as: If the lymphoma responds well to initial treatment, a stem cell transplant may be a good option.

Extranodal marginal zone B-cell lymphoma — mucosa-associated lymphoid tissue MALT lymphoma Gastric stomach MALT lymphoma, the most common type, often occurs as a result of a chronic infection with the bacterium H.

Stages I and II gastric lymphoma in people who test positive for H. Stages I and II gastric lymphoma in people who test negative for H. Non-gastric MALT lymphoma For MALT lymphomas that start in sites other than the stomach non-gastric lymphomas, treatment depends on the location of the lymphoma and how much it has spread.

I have a few patients whose friends or neighbors receive routine images and wonder if they might benefit from them. Most patients are satisfied by a discussion about the potential benefits and risks of routine images in remission.

However, if the patient wants the images, I am willing to do them. Perhaps the most important issue in caring for patients with diffuse large B-cell lymphoma in remission is never to initiate treatment for relapse in the absence of a biopsy that proves relapse.

In the past few years we have had patients in whom we considered starting therapy for what seemed obvious relapse who, on biopsy, had histoplasmosis, coccidiomycosis, and sarcoidosis. Patients who achieve a complete remission and might be cured should never be treated for relapse without proving recurrence of their lymphoma.

When fluorodeoxyglucose PET hereafter referred to as PET scans were first introduced into the care of patients with lymphoma, it was quickly apparent that they had great potential to influence care.

Diffuse large B-cell lymphoma is one of the most consistently PET-avid lymphomas. It has become clear that PET scans are more accurate than CT scans in proving complete remission and that a negative PET scan result has the greatest impact in predicting progression-free and overall survival.

I try to have a PET scan performed as part of staging in all patients with diffuse large B-cell lymphoma. Achieving a negative PET scan result is the criterion I use for documenting complete remission.

However, a borderline-positive PET scan at the completion of therapy does not necessarily mean persistent disease. In patients with localized disease, radiotherapy is often administered in this setting.

In patients with disseminated disease, either performing a biopsy or waiting for 1 to 2 months and repeating the scan to see if results have normalized is a reasonable approach. One of the new topics in applying PET scans to the treatment of patients with diffuse large B-cell lymphoma is the use of early, or interim, scans to predict treatment outcome after only 1 to 3 cycles of treatment.

Some studies, 50,51 but not all, 52,53 have found a dramatic impact on eventual treatment outcome. At the present time I do not use PET scans after 2 or 3 cycles of treatment to direct therapy.

However, it is possible that this will become the standard treatment approach in the future. Although surveillance PET scans in patients with diffuse large B-cell lymphoma in remission are not specific and should not be routinely performed, in patients in whom relapse is suspected, PET scans can be extremely useful in identifying the best site to biopsy.

Unfortunately, many insurance companies will not authorize a PET scan in this setting. Patients with congestive heart failure who develop diffuse large B-cell lymphoma present a difficult problem.

Doxorubicin, the most active traditional chemotherapeutic agent in diffuse large B-cell lymphoma, is associated with a significant risk of worsening of the heart failure, and most physicians believe it would be contraindicated.

A number of approaches have been proposed to treat these patients. These include deleting doxorubicin from CHOP-R, substituting mitoxantrone for doxorubicin, substituting liposome-encapsulated doxorubicin, 55 substituting etoposide for doxorubicin, using bendamustine-R, 56 and substituting procarbazine for doxorubicin.

The approach that I have adopted was recently reported by the Vancouver group. These patients were matched 2: The version of the World Health Organization WHO classification of lymphoid malignancies recognizes numerous subtypes of diffuse large B-cell lymphoma.

In addition, there are tumors that exist on the interface between diffuse large B-cell lymphoma and Burkitt lymphoma and between mediastinal large B-cell lymphoma and Hodgkin lymphoma, other rare clinical presentations such as leukemic diffuse large B-cell lymphoma, double-hit diffuse large B-cell lymphomas, and those with a very high proliferative rate—often with an MYC translocation.

As we become more sophisticated at subdividing patients with diffuse large B-cell lymphoma, it would seem reasonable to suspect that biologically unique entities might be identified that would require special treatment approaches.

It is increasingly clear that this is, in fact, the case. I will deal here with those groups in which I believe modification of the therapeutic approach is appropriate Table 3.

Plasmablastic lymphoma is a diffuse proliferation of large cells that resemble immunoblasts but have the immunophenotype of plasma cells. This lymphoma was originally thought to be seen predominantly in individuals positive for the human immunodeficiency virus HIV, with presentation involving the oral cavity.

However, it is now clear that this lymphoma can also occur in patients who are not infected with HIV and have other, although predominantly extranodal, presenting sites. Therapy with rituximab will not benefit these patients, and it should not be used unless the patient has one of the rare plasmablastic lymphomas that is CDpositive.

It is possible that combining drugs such as bortezomib with CHOP, or performing autotransplants in remission for those patients who achieve a complete remission, might improve the treatment outcome.

Lymphomatoid granulomatosis is an Epstein-Barr virus—positive B-cell lymphoproliferative disorder that usually arises in patients with no history of immunodeficiency. The condition is a progressive immune disorder that involves the lung and other organs such as the CNS, skin, liver, and kidney.

The disorder is an angiocentric and angiodestructive process that is known to evolve into diffuse large B-cell lymphoma in some cases. Grade 3 lymphomatoid granulomatosis is often monoclonal and often evolves into, and behaves like, diffuse large B-cell lymphoma.

Patients with low-grade lymphomatoid granulomatosis can be effectively managed with interferon or rituximab, and some patients can have durable responses. Investigators at the US National Cancer Institute have utilized EPOCH-R for patients with high-grade or transformed lymphomatoid granulomatosis and for patients with low-grade disease in whom interferon therapy failed and have found a high overall survival.

My approach is to treat patients whose disease is transforming to diffuse large B-cell lymphoma with CHOP-R, and I have treated patients with lower-grade disease with rituximab.

It is important to realize that some patients who present with diffuse large B-cell lymphoma arising in lymphomatoid granulomatosis and achieve a remission will relapse with lower-grade lymphomatoid granulomatosis.

I have one such patient who underwent salvage treatment with rituximab and has had a durable remission. Diffuse large B-cell lymphoma presenting as a brain tumor, with or without meningeal or ocular involvement, is being seen increasingly in HIV-negative patients.

Therapy with CHOP-R or with primary radiotherapy has a poor outcome, with a median survival of less than 1 year. This is a particularly serious problem in patients who are treated after 60 years of age.

However, in patients in whom primary chemotherapy regimens fail, radiotherapy provides an important palliative option. Diffuse large B-cell lymphoma is the most common testicular tumor in men older than 60 years.

It has been known for some time that this lymphoma follows an atypical clinical course. Patients often have recurrent disease in the opposite testicle if they do not receive scrotal radiotherapy, and CNS metastases ie, sometimes parenchymal masses occur frequently.

Of course, these patients remain at risk for late relapse. At the present time I believe this is the best treatment approach for patients with primary testicular lymphoma and the one that I offer to my patients.

Patients with cutaneous B-cell lymphomas who are diagnosed as having diffuse large B-cell lymphoma might fit into 1 of 2 categories. Primary cutaneous diffuse large B-cell lymphoma, leg type, typically presents on the lower legs of elderly women.

I have seen other patients with cutaneous B-cell lymphoma, often presenting on the scalp and often in younger patients, diagnosed as diffuse large B-cell lymphoma. These tumors probably belong in the WHO category primary cutaneous follicle center cell lymphoma.

Because the treatment and prognosis vary so widely, it is important to make every effort to distinguish between these 2 entities. Intravascular and leukemic diffuse large B-cell lymphoma represent 2 other variants.

Both are rare presentations of diffuse large B-cell lymphoma. Only the intravascular large B-cell lymphoma has a category in the WHO classification. The tumors grow in association with endothelial cells and can disrupt the function of any involved organ.

However, the last patient I saw presented with liver failure. In the absence of a high degree of suspicion, these patients might not be diagnosed until an autopsy. In fact, they are often subjects of clinicopathologic conferences.

There is also an Asian variant that typically presents with hepatosplenomegaly, pancytopenia, and hemophagocytic syndrome. Patients with intravascular diffuse large B-cell lymphoma usually respond to CHOP-R or similar regimens and can have long-term, disease-free survival if they achieve a complete remission.

Patients with diffuse large B-cell lymphoma that presents with leukemia ie, circulating large lymphoma cells have been thought to have a terrible prognosis. However, a recent series of patients treated at Emory University and the University of Nebraska showed that these patients can achieve a complete remission when treated with rituximab-containing regimens and that these remissions can be durable.

A number of subgroups of diffuse large B-cell lymphoma fit under this heading. There is considerable overlap among these groups. It does appear clear that, when treated with CHOP-R—like regimens, patients with double-hit diffuse large B-cell lymphoma have a very poor prognosis, with reported survival ranging from 4 to 25 months and the poorest survival in the largest series.

Patients with lymphomas intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma have been reported to have a poorer outcome than those with typical diffuse large B-cell lymphoma, but these patients often have adverse genetic abnormalities, including double hits.

My approach for patients with double-hit lymphomas, tumors that are identified as being at the interface between diffuse large B-cell and Burkitt lymphoma, and tumors that are MYC – positive is to use EPOCH-R.

The infusional regimen has been shown to have a high cure rate in patients with Burkitt lymphoma 81 and to be at least as effective as CHOP-R in patients with typical diffuse large B-cell lymphoma.

I consider performing an autotransplant in first remission, particularly in patients with double-hit lymphomas. These lymphomas are at the interface between mediastinal diffuse large B-cell lymphoma and classic Hodgkin lymphoma.

They display both morphological and immunophenotypic features typically found in nodular sclerosing Hodgkin lymphoma and mediastinal large B-cell lymphoma. Interestingly, a recent report from investigators at the National Cancer Institute suggested that patients with mediastinal gray zone lymphoma had a much poorer outcome when treated with EPOCH-R than similar patients with typical mediastinal large B-cell lymphoma.

This treatment can be curative. Whether these patients would be better treated with Hodgkin lymphoma—like regimens, have autotransplants as part of their primary therapy, 84 or have entirely different treatment approaches needs to be resolved.

We have known for some time that patients with the activated B-cell ABC genetic subtype of diffuse large B-cell lymphoma have a poorer outcome than those with the germinal center B-cell subtype.

This is leading to prospective trials of bortezomib-containing combination chemotherapy regimens in patients with ABC-type diffuse large B-cell lymphoma. A subset of patients with diffuse large B-cell lymphoma overexpresses the protein CD30, which is typically found in anaplastic large-cell lymphoma, albeit at a lower concentration than seen in anaplastic large-cell lymphoma.

In addition, a subset of patients with diffuse large B-cell lymphoma overexpresses the protein anaplastic lymphoma kinase ALK. It has become clear that the entity we call diffuse large B-cell lymphoma is made up of a variety of clinicopathologic syndromes that should not all have identical treatment.

As we better understand the biological explanation for these differences eg, site of involvement, proliferative rate, we might develop more specific and more effective therapies.

In the meantime, trying to optimize use of currently available tools eg, PET scans, chemotherapeutic agents, radiotherapy through clinical studies will increase our ability to benefit patients with diffuse large B-cell lymphoma.

This remains a work in progress, but patients have gained much by the work done to date. National Center for Biotechnology Information, U. Journal List Mayo Clin Proc v.

Address to James O. This article has been cited by other articles in PMC. Abstract My favored treatment approach for patients with diffuse large B-cell lymphoma continues to evolve.

What Has Not Changed? Approach to the Patient Diffuse large B-cell lymphoma is a potentially fatal but also a potentially curable illness. Diagnosis The most important step in the treatment of patients with this lymphoma continues to be an accurate diagnosis.

Central Nervous System Prophylaxis One of the most serious complications for a patient with diffuse large B-cell lymphoma who presents with disease outside the central nervous system CNS is the development of CNS metastasis.

The Use of Radiotherapy Controversy continues regarding the place of radiotherapy in the management of patients with diffuse large B-cell lymphoma who have sites of bulky disease at presentation.

The Place of Transplantation Autologous hematopoietic stem cell transplant remains the best treatment for patients with chemotherapy-sensitive relapse. Surveillance Imaging in Remission There is still no proof that surveillance imaging benefits patients with diffuse large B-cell lymphoma being followed up in remission.

The Diagnosis of Relapse Perhaps the most important issue in caring for patients with diffuse large B-cell lymphoma in remission is never to initiate treatment for relapse in the absence of a biopsy that proves relapse.

Increasing Importance of PET Scans When fluorodeoxyglucose PET hereafter referred to as PET scans were first introduced into the care of patients with lymphoma, it was quickly apparent that they had great potential to influence care.

Patients With Heart Disease Patients with congestive heart failure who develop diffuse large B-cell lymphoma present a difficult problem. Morphologic Variants Requiring Treatment Modification Plasmablastic lymphoma is a diffuse proliferation of large cells that resemble immunoblasts but have the immunophenotype of plasma cells.

Specific Anatomic Sites That Require Treatment Modification Diffuse large B-cell lymphoma presenting as a brain tumor, with or without meningeal or ocular involvement, is being seen increasingly in HIV-negative patients.

Mediastinal Gray Zone Lymphoma These lymphomas are at the interface between mediastinal diffuse large B-cell lymphoma and classic Hodgkin lymphoma.

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When deciding how often these visits should occur, the patient and physician must consider the following:. Patients often have recurrent disease in the opposite testicle if they do not receive scrotal radiotherapy, and CNS metastases ie, sometimes parenchymal masses occur frequently. When fluorodeoxyglucose PET hereafter referred to as PET scans were first introduced into the care of patients with lymphoma, it was quickly apparent that they had great potential to influence care. Because current treatments for this type of lymphoma are very unlikely to cure it, patients might want to consider taking part in a clinical trial. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas:

The Place of Transplantation Autologous hematopoietic stem cell transplant remains the best treatment for patients with chemotherapy-sensitive relapse. Rituximab may be added as well. Some people may never need treatment at all.

Please share your thoughts about your cancer. The International Prognostic Index IPI, which includes five parameters age, performance status, stage, lactate dehydrogenase level, and extranodal site involvement, is the most commonly used means of risk stratification in DLBCL and has been further validated in the rituximab era [ 4 ]. In the meantime, trying to optimize use of currently available tools eg, PET scans, chemotherapeutic agents, radiotherapy through clinical studies will increase our ability to benefit patients with diffuse large B-cell lymphoma.

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Follicular lymphoma This type of lymphoma often grows slowly and responds well to treatment, but it is very hard to cure. The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma. Please review our privacy policy. See…

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