Based on the data of the International NHL study group (Non-Hodgkin's Lymphoma classification Project 1997) and the fourth edition of the WHO Classification of Tumour of Haematopoietic and Lymphoid Tissues, DLBCL accounts for approximately 31% of all NHL in Western ClassificationĭLBCLs are defined as a heterogeneous group of malignancies composed of large cells with nuclei at least twice the size of a small lymphocyte and usually larger than those of tissue macrophages. At present time, in Europe and USA the annual incidence of Non-Hodgkin's Lymphomas (NHL) is estimated to be 15–20 cases/100,000. Section snippets Definition and incidenceĭiffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy in adults. Several novel agents are undergoing evaluation in DLBCL among other, immunomodulating agents (lenalidomide), m-TOR inhibitors (temsirolimus and everolimus), proteasome inhibitors (bortezomib), histone deacetylase inhibitors (vorinostat), and anti-angiogenetic agents (bevacizumab) are being investigated in prospective trials. New effective and less toxic chemotherapy drugs or biological agents are also worth considering for this specific and broad group of patients. Overall results in patients who cannot be managed with HDC/ASCT due to age or comorbidity are disappointing. HDC/ASCT should be considered the standard therapy for DLBCL patients with chemotherapy-sensitive relapse. Patients with high IPI score, which indicates increased LDH serum level and the involvement of more than one extranodal site, and patients with involvement of certain extranodal sites (a.e., testes and orbit) should receive CNS prophylaxis as part of first-line treatment. Consolidation radiotherapy should be reserved to patients with bulky disease who did not achieve CR after immunochemotherapy. HDC/ASCT is actually recommended in young patients who did not achieve CR after first-line chemotherapy. Recent randomized trials suggest that high-dose chemotherapy supported by autologous stem cell transplant (HDC/ASCT) should not be used as upfront treatment for young high-risk patients outside prospective clinical trials. The combination of the anti-CD20 monoclonal antibody rituximab and CHOP chemotherapy, every 14 or 21 days, is the standard treatment for DLBCL patients. The International Prognostic Index (IPI) and age adjusted IPI (aaIPI) are the benchmarks of DLBCL prognosis.įirst-line treatment for patients with DLBCL is based on the individual IPI score and age, and three major subgroups should be considered: elderly patients (>60 years, aaIPI = 0–3) young patients with low risk (<60 years, aaIPI = 0–1) young patients with high risk (<60 years, aaIPI = 2–3). Cure rate is particularly high in patients with limited disease with a 5-year PFS ranging from 80% to 85% patients with advanced disease have a 5-year PFS ≈ 50%. Overall, DLBCLs are aggressive but potentially curable malignancies. Disseminated extranodal disease is less frequent, and one third of patients have systemic symptoms. These malignancies present in localized manner in approximately 20% of patients. Clinical presentation, behaviour and prognosis are variable, depending mainly of the extranodal site when they arise. DLBCL–NOS occurs in adult patients, with a median age in the seventh decade, but the age range is broad, and it may also occur in children. However, a large number of cases still remain biologically and clinically heterogeneous, for which there are no clear and accepted criteria for subclassification these are collectively termed DLBCL, not otherwise specified (NOS). Following, morphological, biological and clinical studies have allowed the subdivision of DLBCLs into morphological variants, molecular and immunophenotypic subgroups and distinct disease entities. ![]() Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy in adults accounting for 31% of all NHL in Western Countries.
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