Treatment Protocol for Diffuse Large B-cell NHL (DLBCL)
Treatment Protocol for Diffuse Large B-cell NHL (DLBCL)
I. Introduction:
The commonest adult NHL: 30−40%.
A diverse group of neoplasms with heterogeneous genetic abnormalities, clinical features, treatment responses, and prognoses.
The WHO classification classified DLBCL as a mature B-cell neoplasm.
They usually arise de novo (referred to as primary) but can represent progression/transformation (referred to as secondary) of a less aggressive lymphoma, for example, chronic lymphocytic leukemia,
follicular lymphoma, marginal zone B-cell lymphoma,
or nodular lymphocyte-predominant Hodgkin's lymphoma.
The median age is in the sixth decade.
Patients frequently have a rapidly enlarging mass or acute onset of symptoms. Extranodal involvement is seen in 40% of cases.
DLBCL is curable with combination chemotherapy and should be treated promptly and aggressively.
The overall survival (OS) and progression-free survival (PFS) are approximately 50% and 32%, respectively, at 5 years.
II. For previously untreated DLBCL:
A. Localized/limited stage (stage I and nonbulky stage II disease):
1.Age < 60 y/o:
3 cycles of CHOP(CEOP) with involved field radiation(IFR)
(SWOG trial),
based on survival advantages through the first 9 years and
less associated toxicity. (Better than 8 cycles of CHOP)
SWOG trial involved field radiation: dose and schedule?
2.Age 60-80 y/o:
8 cycles of CHOP(CEOP) plus rituximab (375 mg/m2) given on day 1 of each cycle every 3 weeks.
B. Localized/limited stage (bulky stage II disease, three or more disease sites and/or a modified IPI score of 3 or more):
1.Age < 60 y/o:
8 cycles of CHOP(CEOP)
plus IFR for bulky disease
(Definition of bulky disease: 5 cm??)
8 cycles of CHOP(CEOP) plus rituximab (375 mg/m2): optional without evident support currently
2.Age 60-80 y/o:
8 cycles of CHOP(CEOP) plus rituximab (375 mg/m2) given on day 1 of each cycle every 3 weeks.
plus IFR for bulky disease
C. Nonlocalized DLBCL: low and low-intermediate risk IPI group DLBCL patients
1.Age < 60 y/o:
8 cycles of CHOP(CEOP)
plus IFR for bulky disease
CHOP: CR rates of 45−53%, with 30−37% long-term survivors.
8 cycles of CHOP(CEOP) plus rituximab (375 mg/m2): optional without evident support currently
2.Age 60-80 y/o:
8 cycles of CHOP(CEOP) plus rituximab (375 mg/m2) given on day 1 of each cycle every 3 weeks.
plus IFR for bulky disease
D. Therapy for high-intermediate and high-risk IPI group DLBCL patients
1.Age < 60 y/o:
8 cycles of CHOP(CEOP)
plus IFR for bulky disease
Current therapy with CHOP is unsatisfactory for patients with DLBCL in high-intermediate or high-risk IPI categories, with 54 and 34% 2 year survivals, respectively.
Other options: if feasible
8 cycles of CHOP(CEOP) plus rituximab (375 mg/m2)
High-dose chemotherapy (HDT) with autologous stem cell rescue
(Timing: after CR or PR?; Regimen: )
2.Age 60-80 y/o:
8 cycles of CHOP(CEOP) plus rituximab (375 mg/m2) given on day 1 of
each cycle every 3 weeks.
plus IFR for bulky disease
III. Primary refractory DLBCL:
Progressive disease after 1-2 cycles of CEOP: change to ESHAP
Rapidly regrowed disease between C/T:
CEOP every 2 weeks (German and Japanese trials)
IFR for bulky disease
Chemosensitive (CR or PR) disease after salvage regimen:
Consider HDT with ASCT
Age ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- b cell lymphoma drugs
- small b cell lymphomas
- large b cell lymphoma stages
- large b cell lymphoma survival
- stage 4 diffuse large b cell lymphoma
- diffuse b cell lymphoma
- treatment of b cell lymphoma
- large b cell lymphoma prognosis
- large b cell lymphomas
- aggressive large b cell lymphoma
- treatment for diffuse large b cell lymphoma
- diffuse large b cell lymphoma treatment