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ACR Appropriateness Criteria® Diffuse Large B-Cell Lymphoma.
Bouthaina S Dabaja1, Ranjana Advani, David C Hodgson
1*University of Texas MD Anderson Cancer Center, Houston, TX †American Society of Clinical Oncology, Stanford Cancer Center, Stanford, CA ‡Princess Margaret Hospital, Toronto, Ontario, Canada §University of Rochester Medical Center ‡‡‡University of Rochester Medical Center, Rochester †††American Society of Clinical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY ∥American Society of Clinical Oncology, Emory University, Atlanta, GA ¶Univeristy of Texas Health Science Center at San Antonio, San Antonio, TX #University of Florida Proton Therapy Institute, Jacksonville **University of Florida, Gainesville, FL ††American Society of Clinical Oncology, St. Jude Children's Research Hospital, Memphis, TN ‡‡University of Pennsylvania Health System, Philadelphia, PA §§Yale University School of Medicine, New Haven, CT ∥∥Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN ¶¶American Society of Hematology, University of Chicago, Chicago, IL ##Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD ***Massachusetts General Hospital, Boston, MA.
This review details diffuse large B-cell lymphoma management, focusing on diagnosis, chemotherapy, and radiation therapy. Positron emission tomography/computed tomography aids in predicting outcomes and guiding treatment decisions.
Area of Science:
- Oncology
- Hematology
- Medical Imaging
Background:
- Diffuse large B-cell lymphoma (DLBCL) management relies on accurate diagnosis, including molecular and immunophenotypic features, staging, and prognostic scores.
- Current treatment strategies involve chemotherapy regimens, with ongoing evaluation of radiation therapy's role.
Purpose of the Study:
- To provide a comprehensive overview of DLBCL management.
- To discuss the evolving role of radiation consolidation in DLBCL treatment.
- To highlight the utility of positron emission tomography/computed tomography (PET/CT) in predicting outcomes and guiding therapy.
Main Methods:
- Review of existing literature on DLBCL diagnosis and treatment.
- Analysis of randomized trials, prospective studies (UNFOLDER/RICOVER-60), and retrospective studies concerning radiation therapy.
- Examination of the application of American College of Radiology Appropriateness Criteria for imaging and treatment.
Main Results:
- Chemotherapy regimens are central to DLBCL treatment.
- Evidence suggests a potential benefit of radiation therapy as consolidation for both early and advanced stage DLBCL, particularly from recent studies.
- PET/CT is valuable for outcome prediction and potentially guiding therapy in DLBCL.
Conclusions:
- DLBCL management is multifaceted, integrating diagnostic characteristics, chemotherapy, and potentially radiation therapy.
- PET/CT plays a crucial role in prognostication and treatment individualization.
- Evidence-based guidelines, like the ACR Appropriateness Criteria, inform clinical decision-making for imaging and treatment in DLBCL.
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