Since diffuse large B-cell lymphoma is aggressive and grows rapidly, immediate treatment is required, which is determined by how far the cancer has spread, and includes chemotherapy, radiation therapy, biologic therapy (CAR T Cell therapy), and bone marrow transplant (stem cell transplant).
Chemotherapy – Chemotherapy for diffuse large B-cell lymphoma is usually the primary treatment, for which a four-drug regimen called R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone ) is administered in cycles of 3 weeks apart. The number of cycles may be increased depending on the stage of the cancer and/or may be followed by radiation therapy. Chemotherapy may be administered via pill (orally), intravenously (IV), or, in severe cancer, intrathecally (directly into spinal fluid).
The drug methotrexate may also be administered during R-CHOP or another chemotherapy drug, etoposide (Vepesid), also known as R-EPOCH, may be used. Additional rounds of chemotherapy may be necessary for recurrent diffuse large B-cell lymphoma.
Radiation therapy – Radiation therapy uses high energy sources, such as X-rays and protons, to kill cancer cells and can be used alone or in combination with other treatments. Radiation therapy for diffuse large B-cell lymphoma is directed at the affected lymph nodes and areas where the cancer may progress and may be repeated several times a week.
Biologic therapy – Biologic therapy helps the body’s immune system attack and kill cancer cells. CAR T cell (chimeric antigen receptor T cells) therapies or monoclonal antibody therapies (Rituxan) or ibrutinib (Imbruvica) target areas on cancer cells and may be used in diffuse large B-cell lymphoma after two or more other treatments have been tried.
Additional biologic therapies include radioimmunotherapy drugs made of monoclonal antibodies that carry radioactive isotopes that attach to cancer cells, delivering radiation directly to the cells, such as ibritumomab tiuxetan (Zevalin).
For patients with recurrent diffuse large B-cell lymphoma after two prior therapies, a new drug, polatuzumab vedontin-piiq (Polivy), which is an engineered antibody attached to a chemotherapy drug, may be administered in combination with the chemotherapy agents, bendamustine and rituximab (BR).
Bone marrow transplant (Stem cell transplant) – Bone marrow transplant, also known as stem cell transplant, may be available to selected patients, especially those with recurrence of diffuse large B-cell lymphoma, and uses high-dose chemotherapy and radiation first to suppress bone marrow (where blood cells are produced), and then healthy bone marrow stem cells from the patient (autologous stem cell transplant) are infused into the blood to help rebuild normal bone marrow and cells.