, Volume 2, Issue 3, pp 150-153
Date: 01 Nov 2009

Treatment of diffuse large B-cell lymphomas

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Over 30 years ago, the combination of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) was demonstrated to induce complete remissions and long-term disease-free survival in a considerable proportion of lymphoma patients. Since then many attempts to improve results by modifications of CHOP using escalated doses, additional drugs or the alternative use of putatively non-cross resistant chemotherapy regimens failed in randomized trials. While dose escalation strategies including high-dose approaches necessitating stem cell support have not yet unequivocally been demonstrated to be superior to a base-line CHOP-21, dose-dense bi-weekly modifications (CHOP-14) with growth factor support (G-CSF) improved the outcome of young and elderly patients with aggressive lymphomas compared to CHOP-21. A substantial improvement of treatment results has also been achieved by the implementation of rituximab into treatment protocols. Although not formally established in young patients with poor-prognosis, the combined immuno-chemotherapy with CHOP and rituximab has become an accepted standard for the treatment of diffuse large B-cell lymphoma (DLBCL) worldwide. For patients >60 years of age 6 courses CHOP-14 using G-CSF with rituximab (R-CHOP-14) followed by two additional courses of rituximab yielded the best treatment results without a relevant increase in toxicity compared with CHOP-21. For younger low-risk patients (aaIPI 0,1) 6 courses R-CHOP-21 are the standard treatment. Young high-risk patients (aaIPI ≥ 2) should be treated with dose-dense regimens within clinical trials.