Diffuse Large B-Cell Lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma in adults worldwide. It affects B cells, which play an important role in the immune system. In DLBCL, B-cells turn malignant and form rapidly growing masses in the lymph nodes, spleen, liver, bone marrow or other organs. In addition, they displace the healthy and functional white blood cells, leading to an impaired and heavily weakened immune system. It is an aggressive disease with about one in three patients not responding to initial therapy (refractory disease) or relapsing thereafter. In the United States, each year approximately 10,000 patients are diagnosed with relapsed or refractory DLBCL who are not eligible for ASCT (autologous stem cell transplant, a procedure that uses a person’s own healthy stem cells that form blood cells to replace diseased or damaged bone marrow).
Early symptoms of DLBCL may include swollen lymph nodes, persistent fever, night sweat or unexplained weight loss. There may also be manifestations outside of the lymph nodes, for example in the gastro-intestinal tract, the liver, the lung or the testicles.
DLBCL also may have rare subtypes, such as:
- Primary mediastinal B-cell lymphoma (also known as PMBCL; a form of non-Hodgkins lymphoma that affects mature B-lymphocytes)
- Double- and triple-hit lymphoma (also known as DHL and THL; a rare subtype of lymphoma with a typically poor prognosis)
- Transformed follicular lymphoma (also known as tFL; a transformation of follicular lymphoma into a more aggressive lymphoma)
The current treatment of DLCBL consists of systemic therapies to treat cancer cells throughout the body. These therapies include chemotherapy, radiotherapy, hematopoetic stem cell transplant or other cell therapies. When DLBCL relapses or stops responding to certain treatments (refractory) your doctor may start you on another type of treatment to help control the disease. Half of the patients are not able to receive hematopoetic stem cell transplant for different reasons or relapse thereafter.
In relapsed/refractory DLBCL, systemic therapies include:
- Platinum-based chemoimmunotherapy regimens
- CHOP-like regimens (a chemotherapy regimen)
- Milder chemotherapies
- Chemotherapy-free regimens
- CAR-T treatment (enhancing a person’s T-cells in the laboratory to attack cancer cells)