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Diffuse large B-cell lymphoma: a consensus practice statement from the Australasian Lymphoma Alliance
Joel Wight1,2,3,4, Nada Hamad5,6,7, Belinda A Campbell8,9,10
1Department of Haematology and Bone Marrow Transplantation, Townsville University Hospital, Townsville, Queensland, Australia.
Internal Medicine Journal
|September 17, 2021
Summary
Diffuse large B-cell lymphoma (DLBCL), the most common lymphoma, has a 60% cure rate with chemoimmunotherapy. Current R-CHOP21 treatment remains standard, but controversies in prognostic markers and high-risk patient care persist.
Area of Science:
- Hematology
- Oncology
- Clinical Practice Guidelines
Background:
- Diffuse large B-cell lymphoma (DLBCL) is the most frequent type of non-Hodgkin lymphoma, representing 30-40% of diagnoses.
- While aggressive, approximately 60% of DLBCL patients achieve a cure with initial chemoimmunotherapy, with further success possible through salvage therapies and stem cell transplantation.
Purpose of the Study:
- To provide an evidence-based synthesis of current literature on DLBCL management.
- To address controversies in prognostic markers, central nervous system prophylaxis, and treatment for high-risk DLBCL patients.
- To guide Australasian clinical practice for DLBCL.
Main Methods:
- Systematic review and evidence synthesis of existing literature.
- Analysis of randomized controlled trials and early-phase clinical trial data.
- Expert consensus on controversial aspects of DLBCL treatment.
Main Results:
- No novel or intensified treatment regimens have demonstrated improved outcomes compared to R-CHOP21 in randomized studies.
- Areas of ongoing debate include optimal prognostic markers, the necessity of central nervous system prophylaxis, and the best approach for high-risk DLBCL patients.
Conclusions:
- R-CHOP21 remains the benchmark treatment for DLBCL.
- Further research and consensus are needed to optimize care for specific patient subgroups, particularly those with high-risk disease.
- This statement offers a framework for evidence-based decision-making in Australasian DLBCL practice.
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