Treatment Options for Diffuse Large B-Cell Lymphoma: A Comprehensive Guide

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, accounting for a significant proportion of diagnosed cases worldwide. As an aggressive but potentially curable form of blood cancer, DLBCL requires prompt and comprehensive treatment. The current standard of care typically involves a multimodal approach combining chemotherapy, targeted therapy, radiation, and in select cases, stem cell transplantation. Early diagnosis and personalized treatment planning are crucial for improving patient outcomes and long-term survival.

Chemotherapy Combined with Targeted Therapy

Chemotherapy remains the cornerstone of DLBCL treatment, especially when combined with monoclonal antibody therapy. The internationally recognized first-line regimen is R-CHOP, which combines rituximab (a CD20-targeting monoclonal antibody) with cyclophosphamide, doxorubicin, vincristine, and prednisone. This combination has significantly improved remission rates and overall survival compared to chemotherapy alone.

For patients diagnosed at an early stage, 4 to 6 cycles of R-CHOP are generally recommended. In more advanced or high-risk cases, physicians may extend treatment to 6–8 cycles based on disease response and prognostic factors such as the International Prognostic Index (IPI). Regular imaging and laboratory assessments help monitor therapeutic effectiveness and guide adjustments in treatment duration.

The Role of Surgery in Diagnosis and Complication Management

While surgery is not a primary treatment for DLBCL, it plays a critical diagnostic role. An excisional lymph node biopsy—often performed surgically—is essential to confirm the histopathological diagnosis and determine the specific subtype of lymphoma.

When Surgery Becomes Therapeutic

In rare instances, surgical intervention becomes necessary to manage disease-related complications. For example, patients with gastrointestinal involvement may develop perforation or obstruction, requiring emergency surgical repair. Similarly, massive splenomegaly can lead to cytopenias due to hypersplenism; in such cases, splenectomy may be considered to alleviate symptoms and stabilize blood counts. These procedures are not curative but serve supportive and palliative purposes in complex clinical scenarios.

Radiation Therapy for Localized Disease Control

Radiation therapy is a valuable adjunct, particularly in early-stage DLBCL. After completing chemotherapy, localized radiotherapy may be administered to areas with bulky disease or residual masses to reduce the risk of local recurrence. This consolidative approach enhances disease control and improves progression-free survival in select patients.

Advances in radiation technology, such as intensity-modulated radiation therapy (IMRT), allow for precise targeting of affected regions while minimizing damage to surrounding healthy tissues. Radiation is typically well-tolerated and used strategically in combination with systemic therapies to maximize treatment efficacy.

Stem Cell Transplantation for High-Risk or Relapsed Cases

For patients with refractory disease, early relapse, or high-risk features, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) offers a potential cure. This intensive approach is most effective in individuals who respond well to salvage chemotherapy and have chemosensitive relapsed disease.

Emerging Alternatives: CAR-T Cell Therapy

In recent years, chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a groundbreaking option for patients who are ineligible for or have failed stem cell transplantation. Treatments like axicabtagene ciloleucel and lisocabtagene maraleucel target CD19-expressing B cells and have demonstrated remarkable response rates in clinical trials, offering new hope for those with limited treatment options.

Ongoing research continues to refine treatment algorithms, explore novel agents, and personalize therapy based on molecular profiling. With advances in immunotherapy, precision medicine, and supportive care, the prognosis for DLBCL patients is steadily improving, making timely access to comprehensive care more important than ever.