Which chemotherapy regimens are used in the treatment of diffuse large B-cell lymphoma (DLBCL)?

Updated: Aug 20, 2020
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Chemotherapeutic regimens used in the treatment of diffuse large cell lymphoma include the following:

  • CHOP: Cyclophosphamide, doxorubicin (Adriamycin), vincristine, and prednisone; standard treatment for early-stage diffuse large cell lymphoma; current data suggest that either 6 cycles of CHOP or 3-4 cycles of CHOP followed by involved-field radiation therapy (IFRT) is reasonable treatment for early-stage, nonbulky diffuse large cell lymphoma (stage IA or IIA, nonbulky)

  • R-CHOP: Rituximab plus CHOP; standard therapy for patients with advanced diffuse large cell lymphoma

  • Dose-adjusted EPOCH (etoposide, prednisone, vincristine [Oncovin], cyclophosphamide, doxorubicin) , plus rituximab [3]

Salvage chemotherapeutic regimens used in relapse therapy include the following:

  • DHAP - Dexamethasone, high-dose cytarabine, and cisplatin
  • ESHAP - Etoposide, methylprednisolone, high-dose cytarabine, and cisplatin
  • MIME - Mesna, ifosfamide, methotrexate, and etoposide
  • IMVP-16 - Ifosfamide, methotrexate, and etoposide

After the first relapse, however, the duration of the second complete response to treatment is frequently shorter than 1 year. Patients whose condition relapses and who have chemoresponsive disease, as evaluated after salvage therapy, should be considered for high-dose chemotherapy followed by stem cell rescue.

Selinexor, an oral selective inhibitor of nuclear export (SINE) compound, is indicated for relapsed or refractory DLBCL in patients previously treated with at least 2 lines of systemic therapy.

Tafasitamab, a humanized Fc-modified cytolytic CD19-targeting monoclonal antibody, in combination with lenalidomide, is indicated for the treatment of adults with relapsed or refractory DLBCL not otherwise specified, including DLBCL arising from low grade lymphoma, and who are ineligible for autologous stem cell transplantation.

See Treatment and Medication for more detail.


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