Among non-Hodgkin's lymphomas, diffuse large B-cell lymphoma (DLBCL) is the most prevalent kind. Lymphocytes, which are white blood cells, are where non-Hodgkin's lymphoma develops. One particular kind of white blood cell is the B cell.
The B cells in DLBCL begin to develop abnormally. B cells often aid in the fight against infections. However, the B cells in a person with DLBCL are larger than normal and function differently from healthy B cells. These malignant cells proliferate rapidly, seize control, and obstruct all normal B cells.
The first line of treatment for DLBCL is typically chemotherapy, however, not everyone responds well to it for a variety of reasons. Furthermore, not every DLBCL patient responds to treatment.
As a result of developments in cancer research, medical professionals now treat DLBCL using novel strategies.
Continue reading to find out more about DLBCL treatments, both available now and in the future.
Treatment options
DLBCL is a cancer kind that is growing quickly. Chemotherapy as a first-line treatment works for certain patients. However, in many instances, an alternative strategy is required. Up to 40% of DLBCL patients experience recurrence of the malignancy following treatment or a partial response to first-line therapy.
Treatment alternatives are now available for individuals whose cancer does not respond to first-line therapy, and advancements have been made in the management of DLBCL and other cancer types. Clinical investigations from the past and present have produced further DLBCL therapies that work well.
CHOP
People were treated with a range of chemotherapy regimens in the early days of DLBCL treatment. The 1970s saw the introduction of CHOP, a particular cocktail of chemotherapy drugs. Early in the 1990s, CHOP was the preferred treatment for a variety of B-cell lymphoma types due to its excellent results.
Prednisone, a steroid, and three chemotherapeutic medications make up CHOP. Together, these drugs kill cancer cells and prevent or inhibit the spread of new ones.
The drugs included in the treatment plan are the reason behind the moniker CHOP:
- C: cyclophosphamide
- H: doxorubicin hydrochloride (Hydroxydaunomycin)
- O: vincristine sulfate (Oncovin)
- P: prednisone
R-CHOP
Researchers looked into ways to improve the CHOP regimen to build on its positive results.
This resulted in the addition of rituximab, a monoclonal antibody kind of drug. It eliminates dangerous intruders in a manner akin to that of your body's antibodies. After adhering to the surface of B cells, it instructs your immune system to eliminate the cells.
It has been demonstrated that adding rituximab improves outcomes for DLBCL patients, particularly for those who have a specific marker (CD20). The R-CHOP combination resulted in a 10-15% increase in the cure rate for DLBCL.
R-CHOP is an acronym for:
- R: rituximab
- C: cyclophosphamide
- H: doxorubicin hydrochloride (Hydroxydaunomycin)
- O: vincristine sulfate (Oncovin)
- P: prednisone
For DLBCL, R-CHOP is now regarded as the first-line treatment.
Rescue chemotherapy combined with a donation of autologous stem cells
If R-CHOP is ineffective, an alternative combination of chemotherapy drugs known as "salvage chemotherapy" may be used. However, there isn't just one typical second combination. If R-CHOP is not effective for your DLBCL, your doctor will talk to you about additional chemotherapy drugs you can try.
Should your lymphoma react favourably to this second round of treatment, autologous stem cell transplantation (ASCT) can be an option for you.
Because ASCT is a complex process, not everyone should undergo it. It entails using your healthy stem cells to get your bone marrow to start producing blood cells normally again. The bone marrow produces stem cells, which develop into various blood cells. However, not everyone has access to enough stem cells for ASCT.
Generally speaking, a stem cell transplant is not a good option if the second round of chemotherapy fails.
Targeted therapies
A class of drugs known as "targeted therapies" is designed to identify and specifically target certain proteins present in or on cancer cells. They only delay or stop the growth of cancer cells, not all other cells.
Targeted medicines often target cancer cells by attacking them with your immune system.
In addition to conventional therapies like chemotherapy, you might be prescribed a medicine for targeted therapy.
One kind of targeted therapy is the use of monoclonal antibodies. Among the monoclonal antibodies utilised in DLBCL treatment are:
- rituximab (Rituxan), is applied as a component of the R-CHOP protocol.
- polatuzumab vedotin (Polivy)
- mosunetuzumab (Lunsumio)
- tafasitamab (Monjuvi)
Another type of targeted treatment for relapsed or resistant DLBCL is nuclear export inhibitors, including selinexor (Xprovio). However, some alternatives work better.
Several aspects of polatuzumab vedotin, or polivy, show promise. In certain cases, polatuzumab may be administered in addition to bendamustine, a chemotherapeutic drug, and rituximab in cases when R-CHOP is not successful in treating DLBCL.
According to additional studies, polatuzumab vedotin may be used in first-line treatment. Based on preliminary data from clinical trials, polatuzumab vedotin may boost survival when vincristine sulphate (Oncovin) is substituted in R-CHOP. However, more investigation is required.
2020 saw the approval of a drug combination consisting of lenalidomide (Revlimid) and tafasitamab (Monjuvi), following clinical trials that showed its efficacy in certain patients.
For those whose DLBCL is unresponsive to R-CHOP and who are not suitable candidates for ASCT, it is advised. Lenalidomide is a chemotherapeutic drug, while tafasitamab is a monoclonal antibody.
If you are unable to handle chemotherapy, your doctor might also suggest mosunetuzumab. People whose health prevented them from tolerating the R-CHOP regimen at the time of diagnosis were included in a 2020 research. According to the study's findings, 58% of participants responded to the mosunetuzumab overall.
CAR T-cell therapy
DLBCL treatment with chimeric antigen receptor (CAR) T-cell therapy is a more recent approach. If R-CHOP and one other chemotherapy regimen don't work, it might be a possibility for you.
Immunotherapy includes CAR T-cell treatment. Researchers have discovered a way to target and eliminate malignant B cells with an individual's T cells, which are an additional component of the immune system.
Clinical trials or therapies
Inquire with your medical team about any clinical studies that are currently being conducted in which you may be eligible to take part. Treatments for DLBCL are advanced through clinical studies. They might also present an opportunity to test a novel, as of yet unproven therapy.
People with DLBCL are presently being enrolled in some clinical trials.
Tafasitamab and lenalidomide together have already been demonstrated to have positive results in patients whose DLBCL does not respond to R-CHOP. A clinical experiment is investigating which medicine will be more beneficial to add: zanubrutinib or tazemetostat. Two drugs used in targeted therapy include zanubrutinib and tazemetostat.
For a long time, R-CHOP has been the recommended course of action. For patients whose DLBCL has not responded to R-CHOP, researchers want to see if a combination of targeted treatments, such as venetoclax, ibrutinib, prednisone, obinutuzumab, and Revlimid (ViPOR), could be helpful.
If R-CHOP is ineffective, having a backup standard treatment plan would be beneficial.
Outlook
DLBCL is a cancer kind that is growing quickly. It's important to begin therapy as soon as possible after a diagnosis. A person's age, the stage of their DLBCL, and any additional medical disorders they may have all have an impact on their chances of surviving DLBCL.
DLBCL has a 65% overall 5-year relative survival rate. This implies that a person with DLBCL has a 65% higher chance of still being alive five years following diagnosis when compared to a person without cancer.
FAQs
Can lymphoma go away without treatment?
It starts in the lymph nodes and might proceed to the spleen or bone marrow. When diagnosed, the majority of individuals with follicular lymphoma are 50 years of age or older. Treatment-free follicular lymphoma may disappear.
Does DLBCL always come back?
Relapsed DLBCL is when the disease returns after the initial treatment, and refractory DLBCL is when the disease does not go into remission after the first treatment. If this occurs, additional care will be required. Your medical team will go over several choices with you.
Is DLBCL fast-growing?
Diffuse large B cell lymphoma (DLBCL), which accounts for around 30% of all lymphomas, is the most prevalent variety of NHL, despite there being over 60 varieties of the disease. Approximately 7 out of 100,000 individuals in the US are impacted by DLBCL each year. A rapidly expanding, competitive type of NHL is DLBCL.
The takeaway
One kind of cancer that causes B cells to become unusually large and fast is called diffuse large B-cell lymphoma (DLBCL). For DLBCL, R-CHOP is usually the initial course of treatment. However, not everyone responds well to chemotherapy, and R-CHOP does not completely cure DLBCL in roughly 40% of cases.
For DLBCL, there are also several more recent therapies available, such as numerous targeted therapy choices. To help you understand what to do next, your doctor will go over your options with you.
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