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Limited-stage diffuse large B-cell lymphoma: current management and challenges.

Xiao-Yin Zhang1, Graham P Collins1, David J Cutter2,3

  • 1Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

British Journal of Haematology
|February 22, 2021
PubMed
Summary

Limited-stage diffuse large B-cell lymphoma (DLBCL) has an excellent prognosis. Optimizing treatment by potentially reducing chemotherapy or radiotherapy (RT) requires careful risk-benefit assessment, especially for elderly or high-risk patients.

Keywords:
DLBCLPETclinical trialslimited stageradiotherapy

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Area of Science:

  • Oncology
  • Hematology

Background:

  • Limited-stage diffuse large B-cell lymphoma (DLBCL) accounts for 25-30% of cases.
  • Standard treatment involves R-CHOP chemotherapy, often combined with radiotherapy (RT).

Purpose of the Study:

  • To review current clinical trial evidence on optimizing treatment for limited-stage DLBCL.
  • To discuss the application of these findings in routine practice, considering patient risk factors and toxicity.
  • To evaluate the role of radiotherapy (RT) in current treatment paradigms.

Main Methods:

  • Review of recent clinical trial evidence.
  • Discussion of treatment optimization strategies, including abbreviated chemotherapy and omission of RT.
  • Consideration of PET-based response-adapted approaches.

Main Results:

  • While R-CHOP alone or combined-modality therapy offers excellent prognosis, there's interest in minimizing toxicity.
  • Studies on omitting RT or abbreviating chemotherapy are mainly in younger, low-risk patients.
  • Evidence does not exclude a benefit from RT, even in low-risk patients; modern techniques have low toxicity.

Conclusions:

  • Individualized risk-benefit assessment, considering multidisciplinary input, is crucial for treatment decisions, especially regarding RT.
  • Optimal treatment for extranodal limited-stage DLBCL depends on the site of origin.
  • Further evidence is needed for applying optimized approaches in elderly or higher-risk patients.