What are Treatments for Diffuse Large B Cell Lymphoma?

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma that grows rapidly but responds well to treatment. To best decide on personalized treatment, a DLBCL specialist analyzes the molecular subtype, stage, and other patient-specific factors. Although DLBCL is potentially curable, the treatment plan typically involves chemotherapy, targeted therapy, immunotherapy, radiation therapy, or a combination of these. 

The treatment of B-cell lymphomas, like DLBCL, depends on their stage, type (indolent or aggressive), and molecular subtype. 

1. Chemotherapy

Chemotherapy is the primary treatment for DLBCL. It involves using medication to kill cancer cells or stop them from growing. The most common regimen is R-CHOP, which includes chemotherapy and immunotherapy; rituximab (an anti-CD20 monoclonal antibody), cyclophosphamide, doxorubicin, vincristine, and prednisone. This regimen is typically given in cycles, with each cycle followed by a rest period to allow the body to recover. 

For more aggressive cases, other chemotherapy regimens like R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) or R-ACVBP (rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) followed by methotrexate and leucovorin consolidation might be recommended.

There are also chemotherapy-free agents to treat DLBCL, but always consult with your healthcare team if you are eligible for receiving these treatments.

2. Targeted Therapy 

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. In the case of DLBCL, targeted therapies may be used to block the growth and spread of cancer cells. One example of a targeted therapy used in DLBCL treatment is the drug ibrutinib (Imbruvica), which blocks a specific protein that DLBCL cells need to survive and grow.

3. Monoclonal Antibodies 

One type of immunotherapy used is called monoclonal antibodies. This class of drugs uses antibodies to kill DLBCL directly by working against proteins found on the surface of B-cells. Rituximab (Rituxan) works against the CD20 protein, binding to this protein and trigging cell death. Other monoclonal antibody therapies include brentixuimab vedotin (Adcetris), nivolumab (Opdivo), pembroluzumab (Keytruda), polatuzumab vedotin-piiq (Polivy), loncastuximab tesirine (Zynlonta) and tafasitamab-cxix (Monjuvi) 

4. CAR-T Cell Therapy 

Chimeric antigen receptor (CAR) T-cell therapy is a type of immunotherapy that helps the patient’s T-cells become efficient at destroying the cancer. For some DLBCL patients, it has cured their cancer.  This involves modifying the patient's own T cells in a laboratory to produce special structures called chimeric antigen receptors (CARs) on their surface. Once these modified T cells are infused back into the patient, they can find and kill DLBCL cells. Currently available CAR T-cell therapies for DLBCL include axicabtagene ciloleucel (Yescarta), lisocabtagene melaleuca (Breyanzi), and tisagenlecleucel (Kymriah).

5. Radiation Therapy

Radiation therapy uses high-energy rays or particles to kill cancer cells. In DLBCL, radiation therapy may be used in combination with chemotherapy, especially in cases where the lymphoma is localized to one part of the body. It can also relieve symptoms in patients with advanced disease.

6. Clinical Trials 

Clinical trials are not just a last resort for treating DLBCL. They can actually provide access to cutting-edge treatments that are not yet approved but show promise over years of testing. The choice of a clinical trial depends on a variety of factors including the patient's age, overall health, the phase of DLBCL, and genetic changes in the lymphoma cells. It's important to discuss all treatment options, including goals and possible side effects, with your healthcare team to help make the best decision. To learn more about your DLBCL clinical trial options, visit HealthTree's DLBCL Clinical Trial Finder. Utilize the advanced filter option to locate trials that you are eligible to participate in. You can create a HealthTree account to favorite your top trial options so you can discuss them with your DLBCL specialist.

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Source: 

• Diffuse Large B-Cell Lymphoma StarPearls