Diffuse Large B-Cell Lymphoma: Treatment Options

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Diffuse Large B-Cell Lymphoma: Treatment Options

Since DLBCL can advance quickly, it usually requires immediate treatment. A combination of chemotherapy and the monoclonal antibody rituximab (Rituxan), with or without radiation therapy, can lead to disease remission in a large number of patients with this form of lymphoma.

The most widely used treatment for DLBCL presently is the combination known as R-CHOP (rituximab [Rituxan], cyclophosphamide [Cytoxan], doxorubicin [Adriamycin], vincristine [Oncovin], and prednisone) The R-CHOP regimen is usually given in 21-day cycles (once every 21 days) for an average of 6 cycles. However, the length and number of cycles given can vary based on the patient’s individual disease and health status. In certain cases 14-day cycles may be used, and for limited stage disease (Stage I or II) 3-4 cycles may be used followed by radiation therapy.

Sometimes an additional chemotherapy drug, etoposide (Vepesid, Toposar, Etopophos), is added to the R-CHOP regimen, resulting in a drug combination called R-CHOEP. A related regimen, called R-EPOCH, involves the same drugs administered as a continuous infusion over 4 days. There are some cases in which R-EPOCH may be the preferred regimen, as in HIV-related DLBCL. While there are differences in toxicity between these regimens, there are no studies to suggest one is significantly better than another.

Another treatment option for DLBCL is polatuzumab vedotin-piiq (Polivy) in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP). In some cases, treatment may involve radiation therapy.

Customized Treatment Based on DLBCL Subtype

A great deal of current research in the field of DLBCL is focused on using precision medicine to select customized treatments based on a patient’s DLBCL subtype. For example, ibrutinib (Imbruvica), a targeted therapy that is FDA approved for use in several other types of lymphoma, has been studied for use in DLBCL to see if it affects the subtypes differently. In a recent phase II clinical trial of patients with relapsed or refractory disease, the ABC subtype of DLBCL was shown to be much more responsive to ibrutinib than the GCB subtype. This is of particular importance considering that the ABC subtype is more likely to respond poorly to standard R-CHOP treatment. Based on this study’s results, an international phase III trial is now underway comparing standard chemotherapy with or without ibrutinib in patients with non-GCB subtypes of DLBCL.

A similar line of research is exploring the addition of lenalidomide (Revlimid) to R-CHOP chemotherapy. The data to date seem to show that this regimen may also work better in the ABC subtype of DLBCL. Doctors are hopeful that this research into adding ibrutinib, lenalidomide, and other agents to the R-CHOP or R-EPOCH regimens will lead to targeted treatments and better outcomes for patients with ABC and the other non-GCB DLBCL subtypes.

Common drugs or drug combinations used as initial treatments for DLBCL include:

  • R-CHOP (rituximab [Rituxan], cyclophosphamide [Cytoxan], doxorubicin [Adriamycin], vincristine [Oncovin], and prednisone)
  • R-EPOCH (rituximab [Rituxan], etoposide [VePesid], cyclophosphamide [Cytoxan], doxorubicin [Adriamycin], vincristine [Oncovin], and prednisone)
  • Rituximab and Hyaluronidase Human (Rituxan Hycela)
  • Pola-R-CHP (polatuzumab vedotin-piiq, rituximab, cyclophosphamide, doxorubicin, prednisone)

To learn about treatments under investigation for DLBCL, download the Diffuse Large B-Cell Lymphoma Fact Sheet.

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