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Treatment of relapsed or refractory diffuse large B cell lymphoma

Arnold S Freedman, MD
Jonathan W Friedberg, MD
Section Editor
Robert S Negrin, MD
Deputy Editor
Rebecca F Connor, 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. It is an aggressive NHL where survival without treatment is measured in months. (See "Classification of the hematopoietic neoplasms".)

Although significant advances have been made in the treatment of patients with DLBCL, the majority are not cured with conventional therapy. Following relapse, at least 60 percent of patients remain sensitive to conventional treatment, but less than 10 percent of patients experience prolonged disease-free survival with second-line treatment regimens [1].

The treatment of relapsed or refractory DLBCL is discussed here; diagnosis, staging, prognostic measures, and the initial treatment of DLBCL are presented separately. (See "Evaluation and staging of non-Hodgkin lymphoma" and "Epidemiology, clinical manifestations, pathologic features, and diagnosis of diffuse large B cell lymphoma" and "Clinical presentation and diagnosis of non-Hodgkin lymphoma" and "Initial treatment of advanced stage diffuse large B cell lymphoma".)

Oncologic emergencies and treatment-related hematologic toxicities are common in patients with DLBCL. Clinicians must always be alert to their potential presence, and be prepared to deal with them urgently and effectively. These issues are discussed separately. (See "Clinical presentation and diagnosis of non-Hodgkin lymphoma", section on 'Oncologic emergencies'.)


Monitoring for relapse — Following the completion of therapy, restaging, and documentation of complete remission, patients are seen at periodic intervals to monitor for treatment complications and assess for possible relapse. At these visits, patients are evaluated with a history, physical examination, blood work, and imaging studies. (See "Initial treatment of advanced stage diffuse large B cell lymphoma", section on 'Surveillance for relapse'.)


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Literature review current through: Sep 2015. | This topic last updated: Jun 17, 2015.
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