Recent Advances in Diffuse Large B Cell Lymphoma

Abstract

More recently, DLBCL has witnessed advances in the molecular profiling and treatment of patients with refractory and relapsed disease. DLBCL is biologically and clinically a heterogeneous disease. Despite its aggressive behavior, DLBCL is a potentially curable disease with overall survival of 94 and 55% in patients with low and high rIPI scores, respectively. The combination of anti-CD 20 monoclonal antibody rituximab and cyclophosphamide, doxorubicin, oncovin (vincristine) and prednisone (R-CHOP) chemotherapy every 3 weeks is the first line treatment. Radiotherapy is reserved for the patients with bulky disease who fail to achieve complete remission after first line treatment. CNS prophylaxis is reserved for the patients with high lactate dehydrogenase (LDH) levels and involvement of more than one extranodal sites and for the patients with involvement of selective extranodal sites like testes and orbits (the sanctuary sites). Patients who suffer relapse after first line treatment receive high-dose chemotherapy supported by autologous stem cell transplantation (HDC/ASCT). Variants of DLBCL like double-hit (presence of MYC and BCL2/BCL6) and triple-hit (presence of MYC, BCL2 and BCL6) lymphomas are treated differently and these patients have worse outcome. Several novel immunotherapeutic agents like checkpoint inhibitors and chimeric antigen receptor T cell (CART) are being investigated in randomized trials on patients with DLBCL.

A Review of Results from Clinical Trials Based on Co-Variants of the R-CHOP Regimen in Untreated Patients with Diffuse Large B-cell Lymphoma

“…The classical algorithm proposed by Hans and colleagues with a panel of antibodies against CD10, BCL6, and MUM-1/IRF4, and the one proposed by Choi and colleagues, correlate well with the corresponding GEP results and highlight survival differences between GCB and non-GCB subtype of DLBCL [ 20]. Unfortunately, in about 10-15% of cases, the ICH study results are not always reproducible [21].…”

“Double expressor” diffuse large B-cell lymphoma: A case report and literature review

“…Those patients with high expression of MYC and BCL2 protein by IHC alone in the absence of gene rearrangements by FISH are labeled as double expressor and they seem to have an intermediate prognosis [14].…”