Treatment of Diffuse Large B-Cell Lymphoma

Treatment

1. Combination treatment with chemotherapy and rituximab The treatment of newly diagnosed diffuse large B-cell lymphoma is based on using a targeted therapy called rituximab together with combination chemotherapy using multiple drugs. In the case of several B-cell lymphoma types, including diffuse large B-cell lymphoma, the cells express an antigen protein called CD20 on their surface. Rituximab is a monoclonal antibody against CD20 (an antibody made to bind only to a specific immune receptor). Once introduced into the body, it binds to the CD20 antigen on the surface of diffuse large B-cell lymphoma cells and destroys cancer cells through various mechanisms.

The most representative chemotherapy regimen is CHOP, in which cyclophosphamide, doxorubicin, vincristine, and prednisolone, a steroid preparation taken orally or by injection, are administered every three weeks. Steroid drugs, known as hormonal agents, have anti-cancer effects in lymphatic system tumors, so they are administered as one of the anti-cancer drugs rather than as hormones or supplements. In Korea, the treatment covered by the National Health Insurance Service is the rituximab-CHOP (R-CHOP) regimen, which adds rituximab to CHOP. Although there may be slight differences in actual practice depending on each patient’s physical condition, including comorbidities, localized diffuse large B-cell lymphoma at Ann Arbor stage 1 or 2 is usually treated with 3 to 4 cycles of R-CHOP followed by radiation therapy to the previously involved site, or with about 6 cycles of R-CHOP alone without radiation therapy. For stages 3 and 4, 6 cycles of R-CHOP is the standard treatment, and radiation therapy and autologous hematopoietic stem cell transplantation may be considered additionally if necessary.

2. The role of radiation therapy The foundation of treatment for diffuse large B-cell lymphoma is rituximab + chemotherapy, represented by R-CHOP, but radiation therapy can also be used as a useful treatment. In the case of localized lesions at stage 1 or 2, after 3 to 4 cycles of rituximab + chemotherapy and confirmation that the lesion has disappeared or significantly regressed, radiation therapy may be administered to the original lesion site. Regardless of stage, if after rituximab + chemotherapy there is concern that some cancer cells remain in a particular area and have not completely disappeared, radiation therapy is administered to that area.

3. Autologous hematopoietic stem cell transplantation In diffuse large B-cell lymphoma, autologous hematopoietic stem cell transplantation may be performed for the purpose of further reducing the recurrence rate after completing the planned rituximab + chemotherapy. Autologous hematopoietic stem cell transplantation is a procedure in which the patient’s own hematopoietic stem cells are collected and frozen before treatment so that high-dose anti-cancer drugs, which can cause permanent damage to the bone marrow’s hematopoietic function, can be used; the cells are then infused back into the body immediately after chemotherapy to preserve bone marrow function. In general, if the expected recurrence rate calculated through the International Prognostic Index and other factors is not high, autologous hematopoietic stem cell transplantation is not performed. In addition, even in cases with a high recurrence rate, the role of autologous hematopoietic stem cell transplantation has somewhat decreased because survival rates have improved since rituximab was added to treatment.

4. When chemotherapy cannot be tolerated due to advanced age, etc. If the patient is very old or has a poor general condition due to existing illnesses, aggressive chemotherapy can worsen the condition further as a result of treatment and, in severe cases, can lead to treatment-related death. In such cases, methods such as administering significantly reduced doses of chemotherapy drugs, using steroids alone, or rituximab monotherapy may be considered. Realistically, these treatment methods are intended not for a cure but only for temporary symptom relief, improved quality of life, and a modest extension of survival.

So far, I have explained the treatment of diffuse large B-cell lymphoma. In the next part, we will look at the side effects of treatment for diffuse large B-cell lymphoma.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal