Swiss Medical Weekly (Jan 2012)
Diagnosis and treatment of diffuse large B-cell lymphoma
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most frequently-occurring type of malignant lymphoma in the Western world. It has an aggressive natural history, with a median survival of less than one year if left untreated. Immunochemotherapy regimens, consisting of the anti-CD20 antibody rituximab typically in combination with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP), are currently the treatment backbone. Despite remarkable progress in improving patient survival, clinical outcomes are still unsatisfactory for certain subsets of patients, including the elderly and very elderly and those with highly aggressive disease. This review outlines some of the current treatment strategies for DLBCL and discusses the main issues that affect clinical practice. aaIPI = age-adjusted International Prognostic Index; ABC = activated B-cell – like; ACVBP = doxorubicin, cyclophosphamide, vincristine, bleomycin and prednisone; ASCO = American Society of Clinical Oncology; BCCA = British Columbia Cancer Agency; CALGB = Cancer and Leukaemia Group B; CEPP = cyclophosphamide, etoposide, procarbazine and prednisone; CHOEP = cyclophosphamide, doxorubicin, vincristine, etoposide and prednisone; CHOP = cyclophosphamide, doxorubicin, vincristine and prednisone; CNS = central nervous system; CORAL = Collaborative Trial in Relapsed Aggressive Lymphoma; CR = complete response; CT = computerised tomography; DFS = disease-free survival; DLBCL = diffuse large B-cell lymphoma; DSHNHL = German High-Grade Non-Hodgkin's Lymphoma Study Group; EFS = event-free survival; EORTC = European Organization for Research and Treatment of Cancer; ESHAP = etoposide, solumedrol, high-dose cytarabine and platinum; EPOCH = etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin; ESMO = European Society for Medical Oncology; FIL = Italian Lymphoma Foundation; FISH = fluorescence in-situ hybridisation; GCB = germinal centre B-cell – like; G-CSF = granulocyte colony-stimulating factor; GELA = Groupe d'Etude des Lymphomes de l'Adulte; HDT = high dose therapy; HIV = human immunodeficiency virus; ICE = ifosfamide, carboplatin and etoposide; IFRT = involved-field radiation therapy; IPI = International Prognostic Index; LDH = lactate dehydrogenase; MInT = MabThera International Trial; NCCN = National Comprehensive Cancer Network; NHL = Non-Hodgkin’s lymphoma; NOS = not otherwise specified; OS = overall survival; PET = positron emission tomography; PMBL = primary mediastinal B-cell lymphoma; PFS = progression-free survival; R = rituximab; RICOVER-60 = Rituximab with CHOP over age 60 years; SCT = stem cell transplantation; SAKK = Schweizerische Arbeitsgruppe für Klinische Krebsforschung; SWOG = Southwest Oncology Group; WHO = World Health Organisation.
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