How is early-stage diffuse large B-cell lymphoma (DLBCL) treated?

Updated: Aug 20, 2020
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Approximately 25% of diffuse large B-cell lymphoma (DLBCL) cases present as early stage. Localized DLBCL is defined as Ann Arbor stage I or II nonbulky disease, and the management of such patients requires an abbreviated course of combined systemic chemoimmunotherapy following by involved-field radiation therapy (IF-XRT). [83, 84]

A phase II study conducted by the British Columbia Cancer Agency treated 308 DLBCL patients with 3 cycles of chemotherapy followed by IF-XRT. The overall progression-free survival (PFS) and overall survival (OS) rates were 80-81% at 5 years and 63-74% at 10 years, respectively. [85]

The Southwestern Oncology Group (SWOG) study 8736 randomly assigned 401 patients with nonbulky stage I or II aggressive B-cell lymphoma to receive either 3 cycles of the cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) regimen followed by IF-XRT at 40-50 cGy versus 8 cycles of CHOP chemotherapy alone. [86] Patients managed with CHOP followed by IF-XRT had better PFS (77% and 64%, respectively, P =.03) and OS (82% and 72%, respectively, P =.02) than patients treated with 8 cycles of CHOP. [87]

An updated analysis after 10 years of follow up showed an increased frequency of late recurrences that explained the absence of a plateau effect in the survival curve.

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