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Initial treatment of limited stage diffuse large B cell lymphoma

Arnold S Freedman, MD
Jonathan W Friedberg, MD
Section Editor
Andrew Lister, MD, FRCP, FRCPath, FRCR
Deputy Editor
Alan G Rosmarin, MD


Diffuse large B cell lymphoma (DLBCL) is the most common histologic subtype of non-Hodgkin lymphoma (NHL), accounting for approximately 30 percent of patients with NHL [1-4]. It is an aggressive NHL in which survival without treatment is measured in months. (See "Classification of the hematopoietic neoplasms".)

The initial treatment of DLBCL is dependent on the extent of disease. The staging system used for NHL focuses on the number of tumor sites (nodal and extranodal) and their location (table 1). For treatment purposes, patients with DLBCL are generally classified as having either limited stage disease or advanced stage disease based on whether or not the tumor can be contained within one irradiation field:

Limited stage disease (usually stage I or II) – Limited stage DLBCL can be contained within one irradiation field. This population accounts for 30 to 40 percent of patients with DLBCL. Limited stage DLBCL is treated primarily with combined modality therapy consisting of abbreviated (ie, three cycles) systemic chemoimmunotherapy (eg, R-CHOP; rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and involved-field radiation therapy (IFRT). Alternatively, six to eight cycles of R-CHOP without radiation therapy may be used.

Advanced stage disease (usually stage III or IV) – Advanced stage DLBCL cannot be contained within one irradiation field. This population accounts for 60 to 70 percent of patients with DLBCL. Advanced stage DLBCL is treated with systemic chemoimmunotherapy. (See "Initial treatment of advanced stage diffuse large B cell lymphoma".)

Patients with bulky (>10 cm) stage II disease and patients with stage IIB disease have a less favorable prognosis than those with non-bulky stage II disease without systemic B symptoms. Many clinicians treat such patients in a similar fashion to those with advanced stage disease. (See 'Bulky disease' below.)

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Literature review current through: Oct 2017. | This topic last updated: Oct 25, 2017.
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