Recent Advances in Diffuse Large B Cell Lymphoma

Abstract

More recently, DLBCL has witnessed advances in the molecular profiling and treatment of patients with refractory and relapsed disease. DLBCL is biologically and clinically a heterogeneous disease. Despite its aggressive behavior, DLBCL is a potentially curable disease with overall survival of 94 and 55% in patients with low and high rIPI scores, respectively. The combination of anti-CD 20 monoclonal antibody rituximab and cyclo- phosphamide, doxorubicin, oncovin (vincristine) and prednisone (R-CHOP) chemotherapy every 3 weeks is the first line treatment. Radiotherapy is reserved for the patients with bulky disease who fail to achieve complete remission after first line treatment. CNS prophylaxis is reserved for the patients with high lactate dehydrogenase (LDH) levels and involvement of more than one extranodal sites and for the patients with involvement of selective extranodal sites like testes and orbits (the sanctuary sites). Patients who suffer relapse after first line treatment receive high-dose chemotherapy supported by autologous stem cell transplantation (HDC/ASCT). Variants of DLBCL like double-hit (presence of MYC and BCL2/BCL6) and triple-hit (presence of MYC, BCL2 and BCL6) lymphomas are treated differently and these patients have worse outcome. Several novel immunothera- peutic agents like checkpoint inhibitors and chimeric antigen receptor T cell (CART) are being investigated in randomized trials on patients with DLBCL. B cell lymphoma, double-hit lymphoma, update, triple-hit lymphoma, R CHOP, DA-R EPOCH B-progenitor cell into B cell. Mature B cells immunoglobulin VDJ gene rearrangement a complete IgM antibody molecule on the cell surface After release from the bone marrow, antigen naïve mature B cells are exposed to antigen in the interfollicular area of the secondary lymphoid tissues. Majority then migrate into the germinal center. Mature antigen exposed B cells prolif-erate in the center of a primary follicle to form the germinal center. The centroblasts mature into centrocytes as they transition into light zone of the germinal center. In the germinal center, B cell undergoes class-switch recombination and somatic hypermutation. Centroblasts are thought to give rise to germinal center B cell (GCB) DLBCL. After transition through the germinal center, B cells can become memory cells or plasmablasts which undergo further development to become plasma cells. Plasmablasts are to give rise to activated B cell like (ABC) DLBCL