JCO Global Oncology (Dec 2021)

Diagnosis and Management of Diffuse Large B-Cell Lymphoma: Society of Medical Oncology, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology Joint Clinical Practice Guideline

  • Raheel Iftikhar,
  • Muhammad Ayaz Mir,
  • Munira Moosajee,
  • Kamran Rashid,
  • Syed Waqas Bokhari,
  • Ahmed Nadeem Abbasi,
  • Tahir Sultan Shamsi,
  • Parvez Ahmed,
  • Hafeez Ud Din,
  • Qamar-un-nisa Chaudhry,
  • Imran N. Ahmad,
  • Mohammad Usman Shaikh,
  • Natasha Ali,
  • Muhammad Umair,
  • Amjad Khan,
  • Mussavir Bangash,
  • Usman Ahmad,
  • Wasim Sattar,
  • Anum Zargham,
  • Azhar Shafi,
  • Ghassan U. Shamshad,
  • Qurratulain Rizvi,
  • Syed Muhammad Irfan,
  • Uzma Zaidi,
  • Naeem Naqi,
  • Humera Mahmood,
  • Asghar Hussain,
  • Ahmed Ijaz Masood,
  • Neelam Siddiqui,
  • Misbah Masood,
  • Mohammad Faheem,
  • Salman Naseem Adil,
  • Zeba Aziz

DOI
https://doi.org/10.1200/GO.21.00320
Journal volume & issue
no. 7
pp. 1647 – 1658

Abstract

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Diffuse large B-cell lymphoma (DLBCL) is the commonest non-Hodgkin lymphoma encountered by hematopathologists and oncologists. Management guidelines for DLBCL are developed and published by countries with high income and do not cater for practical challenges faced in resource-constrained settings. This report by a multidisciplinary panel of experts from Pakistan is on behalf of three major national cancer societies: Society of Medical Oncology Pakistan, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology. The aim is to develop a practical and standardized guideline for managing DLBCL in Pakistan, keeping in view local challenges, which are similar across most of the low- and middle-income countries across the globe. Modified Delphi methodology was used to develop consensus guidelines. Guidelines questions were drafted, and meetings were convened by a steering committee to develop initial recommendations on the basis of local challenges and review of the literature. A consensus panel reviewed the initial draft recommendations and rated the guidelines on a five-point Likert scale; recommendations achieving more than 75% consensus were accepted. Resource grouping initially suggested by Breast Health Global Initiative was applied for resource stratification into basic, limited, and enhanced resource settings. The panel generated consensus ratings for 35 questions of interest and concluded that diagnosis and treatment recommendations in resource-constrained settings need to be based on available resources and management expertise.