IntroductIonCombination chemotherapy with Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP) has been the mainstay of treatment for several decades with complete response rates (RR) of 45-55% and cure rates of approximately 30-35% in aggressive NHL; the addition of the immunotherapeutic agent Rituximab to chemotherapy (R-CHOP) has improved complete RR to 76-86% and OS rates significantly. Nevertheless, variability in response rates, and particularly in event free survival (EFS) and OS, have been observed in these trials, and up to one-third of all patients experience progression or relapse of their disease. Outcomes in relapsed or refractory DLBCL are poor, with a median survival approximating 6 months. Salvage chemotherapy followed by high-dose therapy and autologous stemcell transplantation (HDT-ASCT) is widely considered the standard treatment for relapsed DLBCL, though the ORR and EFS are significantly lower in this setting as compared to those observed in upfront treatment. Many patients, moreover, are not eligible for transplant, and of those that are, about half fail to respond to salvage therapy, becoming ineligible for HDT-ASCT 1 .Recent data indicate that angiogenesis is important in the pathophysiology and prognosis of aggressive histologic subtypes of NHL 2 . Angiogenesis and angiogenic factors are increased in most lymphomas. In addition, angiogenesis has been associated with adverse outcomes or more aggressive clinical behavior in malignant lymphoma. However, the role of angiogenesis might vary in lymphoma subtypes because of the prognostic value of microvessel density and the different Surgical department-Faculty of medicine-Menofia University-Egypt.Background & purpose: Diffuse large B cell lymphoma (DLBCL) is the most common subtype of NonHodgkin lymphoma (NHL). Although cure rates are increased after the addition of Rituximab to the standard CHOP; yet there is a significant number -especially of high risk-patients get relapse and have a poor response to second-line regimens. Novel approaches are needed for DLBCL treatment. We conducted this trial to evaluate the role of metronomic maintenance chemotherapy in patients with high risk DLBCL who enter in complete response (CR) after first line standard chemotherapy. Patients and methods: this is a prospective phase II single arm study done on 40 patients with high risk DLBCL. All patients received metronomic maintenance chemotherapy for one year (who had CR after standard R-CHOP) in the form of oral Cyclophosphamide (50 mg every day), oral Methotrexate (2.5 mg 4 times/week) and high-dose oral Celecoxib (400 mg twice daily). results: thirty five and 65 percent of patients presented with stage III and IV respectively, 29 patients (72.5%) had international prognostic index (IPI) score of 3 (high intermediate), while11 patients (27.5%) had IPI score of 4 or 5 (high). The most common toxicity was grade I and II hematological and gastrointestinal toxicity. Grade I fatigue was the most remarkable side effect noticed in 27.5% of patients. N...

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