Front-line management of diffuse large B cell lymphoma

During the past decade, we have witnessed major advances in the management of diffuse large B cell lymphoma. With modern treatment regimens, approximately 75% of patients with this disorder can be cured in contrast with 40% in the past. The purpose of this review is to discuss the pertinent advances and to highlight areas of consensus and controversy.

The combination of rituximab with cyclophosphamide, doxorubicin vincristine, and prednisone (CHOP) ('R-CHOP regimen') constituted the first major advance in this field. This regimen is associated with superior survival as compared with the same regimen without rituximab, regardless of the patient's age and other factors. This was quickly followed by the introduction of the dose dense 'CHOP-14' regimen given every 14 instead of every 21 days. CHOP-14 is superior to CHOP given every 21 days.

Areas of consensus include: use of rituximab with CHOP as part of front-line treatment, lack of effectiveness of maintenance rituximab in contrast to follicular low-grade lymphomas is also acknowledged, and dose-dense R-CHOP-14 regimen has not been compared head to head with R-CHOP-21. For that reason, there is no generalized consensus as to its effectiveness. Opportunities for further improvements in management based on new biological insights are discussed.