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Cure is the goal — but cell of origin, genetics and response all matter
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma. It often presents as a rapidly growing mass and can be cured in a substantial proportion of patients with chemoimmunotherapy. Cell of origin, genetic rearrangements, stage and response assessment guide treatment, while relapsed disease may be treated with salvage therapy, transplant or CAR-T.
Haematology & Haemato-Oncology
Authored and reviewed by Dr. Sachita Baniya (MBBS, FCPS (Clinical Haematology), NMC 20158). Evidence-based, no fabricated outcomes.
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma. It often presents as a rapidly growing mass and can be cured in a substantial proportion of patients with chemoimmunotherapy. Cell of origin, genetic rearrangements, stage and response assessment guide treatment, while relapsed disease may be treated with salvage therapy, transplant or CAR-T.
Reviewed by Dr. Sachita Baniya, MBBS, FCPS — Consultant Haemato-Oncologist & Clinical Hematologist (NMC 20158). For evaluation, contact the respective hospital or cancer centre — Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital Kathmandu, or Advanced Care Hospital.
Excisional biopsy with immunohistochemistry is preferred. FISH for MYC, BCL2 and BCL6 rearrangements identifies high-grade biology. PET-CT provides staging and baseline metabolic information, and the International Prognostic Index supports risk assessment. Baseline organ function and cardiac assessment are needed before anthracycline-based therapy.
Standard first-line treatment is chemoimmunotherapy, usually R-CHOP or a variant, with radiotherapy for selected limited-stage disease. Interim and end-of-treatment PET-CT assess response. Relapsed or refractory disease is treated with salvage chemotherapy followed by autologous transplant if chemosensitive, or CAR-T in eligible patients. Double-hit and double-expressor biology require more intensive discussion.
Guidelines referenced:
NCCN Guidelines — B-Cell LymphomasESMO Clinical Practice Guidelines — Diffuse Large B-Cell LymphomaWHO Classification of Haematopoietic and Lymphoid TumoursContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.