Cure for DLBC Lymphoma

DLBC is an acronym for "diffuse large B-cell" lymphoma, an aggressive subtype of non-Hodgkin lymphoma, a cancer that attacks the body's lymphatic system (bone marrow, thymus, spleen, lymph nodes). There are numerous subtypes of non-Hodgkin lymphoma, but DLBC is the most common. With treatment, over 50% of patients with DLBC lymphoma are cured.

Staging

• Before treatment can be administered, the stage of DLBC must be determined. For lymphoma, the physician will determine how many lymph node regions are involved as well as the location of the involved lymph nodes. He will assess if other organs are involved too.

  There are four stages of disease, denoted with Roman numerals (I, II, III, IV), stage IV being the most severe. In staging, symptoms are also noted, specifically fever, weight loss or night sweats (called B symptoms), with either the letter "A" placed after the stage (i.e., stage IIA) for no B symptoms or letter "B" placed after the stage if these symptoms are present (i.e., stage IIB).

Treatment of Localized DLBC Lymphoma

• For individuals with early stages of DLBC lymphoma (stage I or II), treatment usually consists of combination chemotherapy with or without radiation. The typical chemotherapy regimen used in DLBC lymphoma is a combination of cyclophosphamide, doxorubicin, vincristine and prednisone, known as CHOP. This regimen may or may not be given along with a drug called rituximab (the regimen is then known as R-CHOP). The cyclophosphamide, doxorubicin, vincristine and rituximab (if appropriate) are intravenously administered at different times during the same day, and prednisone is an oral drug taken for five days. Medications are given every 21 days, usually for three cycles. If radiation therapy is recommended, it is given every day for five days for at least three to four weeks.

Treatment of Advanced DLBC Lymphoma

• For advanced DLBC lymphoma, the standard treatment is chemotherapy and immunotherapy. Again, R-CHOP is the most commonly used regimen, but it is administered over more cycles. For instance, the individual would receive cyclophosphamide, doxorubicin, vincristine and rituximab on the same day plus take prednisone by mouth every five days for 21 days. However, the patient would undergo six to eight cycles of this chemotherapy regimen versus the three cycles recommended for localized disease.

  Other chemotherapy regimens that may be used for advanced DLBC lymphoma include BACOP (bleomycin, adriamycin, cyclophosphamide, oncovin and prednisone), m-BACOD (methotrexate, leucovorin, bleomycin, cyclophosphamide, vincristine and dexamethasone), ProMACE/MOPP (prednisone, methotrexate, leucovorin, doxorubicin, cyclophosphamide and etoposide) and MACOP-B (methotrexate, leucovorin, doxorubicin, cyclophosphamide, vincristine, bleomycin, prednisone and trimethoprim-sulfamethoxazole). These regimens have complicated and variable dosing schedules.

  When undergoing chemotherapy, it is very important to monitor for side effects, especially fever and low blood count, which require admission to the hospital for antibiotics. Many develop nausea, vomiting and/or a hypersensitivity reaction such as itching or burning (usually with first-time administration).

Prognosis and Relapse

• After receiving treatment, half of those with DLBC lymphoma will be cured. The chance of survival for the remaining individuals is difficult to determine. Being older than 60, having an above-normal lactate dehydrogenase level, poor performance status, Ann Arbor clinical stage II or IV, and more than one involved extranodal disease sites all negatively affect survival.

  Screening for DLBC lymphoma relapse is important. Relapse usually occurs two years after initially receiving treatment for DLBC. However, if the disease recurs, individuals have a very slim chance of survival. There are chemotherapy regimens called "salvage chemotherapy" that can be tried, followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation, but still the prognosis is grim.