Haema 2017; 8(1): 18-38
by Theodoros P. Vasilakopoulos1, Μaria Μoschogiannis2, Μaria K. Αngelopoulou1, Gerasimos A. Pangalis2
1Department of Haematology and Bone Marrow Transplantation, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens Laikon,
2Department of Haematology, Athens Medical Center, Athens, Greece
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of non-Hodgkin’s lymphomas. During the last 15 years, there has been great progress in the understanding of the biology and the more accurate classification of DLBCL-NOS (not otherwise specified), which have been divided in 2 broad categories: Those derived from germinal center (GCB) and those derived from activated B-cells (ABC). The incorporation or Rituximab into the standard CHOP chemotherapy (R-CHOP-21) in the beginning of the previous decade has revolutionized the treatment of DLBCL. Indeed, R-CHOP-21 increased cure rates and dictated the reassessment of both the already established prognostic factors and the methods that could be used to further improve outcomes. Following the introduction of R-CHOP-21, no other regimen has either been shown to reproducibly produce better results or has been widely adopted in clinical practice during the last 15 years. However, the improved understanding of the biology of DLBCL has also resulted to the discovery of clinically active novel agents, which will hopefully further improve the outcomes of selected patient subgroups in the near future. In addition to the above considerations, this review also describes current treatment approaches for very elderly patients (>80 years old) with chemotherapy dose reduction (R-mini-CHOP) and for patients with anthracycline contraindication due to underlying heart disease (substitution of doxorubicin by gemcitabine or etoposide), as well as the role of radiotherapy and potential strategies for the prevention of central nervous system relapse.