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Diffuse large B-cell lymphoma (DLBCL) can often be put into remission (partial or full reduction of cancer signs or symptoms) for several years with the current treatments listed below. For some patients after treatment, the disease may come back and once again require treatment to achieve another remission. 

To get the most accurate care for your DLBCL, find your DLBCL specialist. Need help? Take a look at HealthTree’s DLBCL Specialist Directory to locate an expert near you. Need financial support to visit a specialist (travel costs, housing costs, medicine costs)? See here for financial resources to help get you the treatment you need. 

The below includes a list of the treatment names, a brief description, then the most common treatment paths DLBCL patients can expect (first-line therapies, second-line therapies, third+ line therapies). 

Treatment Names and Descriptions 

Non-chemo Therapies

  • Polatuzumab vedotin-piiq (Polivy): CD79b-directed antibody conjugate (attaches to CD79b protein on B-cell's surface and releases anti-cancer medicine into the cancer cell killing it [may also affect normal B-cells]) 
    • Administered by infusion
    • More info about Polivy
  • Tafasitamab-cxix (Monjuvi): CD19-directed monoclonal antibody targeted therapy (attaches to the CD19 protein on B-cells causing the cancer cell and some normal B-cells to die or signals the immune system to kill the cancer cell)
    • Administered by infusion
    • More info about Monjuvi
  • Rituximab (Rituxan): CD20-directed monoclonal antibody targeted therapy 
    • Administered by infusion 
    • More info about Rituxan
  • Lenalidomide (Revlimid): Targeted therapy (boost parts of the immune system so it attacks cancer better)
    • Taken in tablets by mouth
    • More info about Revlimid 
  • Axicabtagene ciloleucel (Yescarta): CAR T-cell therapy (enhances the patient's cancer-killing T-cells to destroy cancerous B-cells and some normal B-cells)
    • Administered by infusion
    • More info about Yescarta
  • Tisagenlecleucel (Kymriah): CAR T-cell therapy
    • Administered by infusion
    • More info about Kymriah
  •  Lisocabtagene maraleucel (Breyanzi): CAR T-cell therapy
    • Administered by infusion
    • More info about Breyanzi
  • Autologous (self) stem cell transplant (autoSCT): Replaces damaged bone marrow stem cells with healthy stem cells
  • Dexamethasone: A corticosteroid often used in combination with a chemotherapy regimen to help reduce inflammation

Chemotherapies

  • CHOP Regimen
    • Cyclophosphamide (Cytoxan): Chemotherapy
    • Hydroxydaunorubicin: Anthracycline antibiotic and topoisomerase inhibitor
      • Blocks an enzyme needed for cell division and DNA repair 
      • Administered by infusion
      • More info about hydroxydaunorubicin
    • Oncovin (Vincristine): Chemotherapy
      • Administered by infusion
      • More info about oncovin
    • Prednisone: Corticosteroid (used in a chemo combination to decrease inflammation)
      • Taken in tablets by mouth 
      • More info about prednisone
  • Other chemotherapies that may be used for DLBCL treatment (administered by infusion)

Current DLBCL Treatment Paths 

First-line therapy options

  • R-CHOP chemoimmunotherapy (healthy adults)
  • Other types of chemoimmunotherapy (frail adults)
  • May add radiation therapy
  • Clinical trial (ask your doctor about available clinical trials)

Second-line Therapies

  • Relapse under 12 months
    • CAR T-cell therapy (yescarta, kymriah or breyanzi)
    • Bridge therapy options until CAR T can be received:
      • Polatuzumab vedotin-pig (bendamustine and/or rituximab may be added)
      • Tafasitamab-cxix and lenalidomide
      • Gemcitabine and oxaliplatin (GemOx)
  • Relapse after 12 months
    • Autologous stem cell transplant (radiation therapy may be added)
      • Bridge therapy options while waiting for the stem cell transplant:
        • Dexamethasone and cytarabine with carboplatin, cisplatin, or oxaliplatin
        • Gemcitabine, dexamethasone, and cisplatin (GDP)
        • Ifosfamide, carboplatin, and etoposide (ICE)
  • If the patient is not receiving CAR T or a stem cell transplant, one of the following can be used: 
    • Polatuzumab vedotin-piiq (bendamustine and/or rituximab may be added
    • Tafasitamab-cxix and lenalidomide
    • Gemcitabine and oxaliplatin 
    • Clinical trial (ask your doctor about clinical trial options) 

Third+ Line Therapies

  • CAR T-cell therapy (yescarta, kymriah or breyanzi)
  • Second-line therapies not yet used
  • Clinical trial (ask your doctor about clinical trial options) 
  • Palliative radiation therapy

Source: NCCN Guidelines for DLBCL Patients

Commonly Asked Questions

Why are some medicines used in a combination? 

  • Data has shown some medicines are more effective at reducing cancer cells when used in combination with another type of treatment

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