Related Subjects:
|Hodgkin Lymphoma
|Non Hodgkin Lymphoma
|Diffuse large B-cell lymphoma
|Intravascular large B-cell lymphoma
|Mantle cell lymphoma
|Marginal Zone Lymphoma
|Gastric (MALT) Lymphoma
|Primary CNS Lymphoma (PCNSL)
|Burkitt's lymphoma
|Follicular Lymphoma
ℹ️ About
- 🎗️ Diffuse Large B-Cell Lymphoma (DLBCL) = most common type of Non-Hodgkin Lymphoma (~30–40% of cases)
- ⚡ Aggressive lymphoma but potentially curable with prompt treatment
- 🧓 Median age: ~65 years; slight male predominance
🧬 Aetiology
- 🔗 Genetic abnormalities:
– t(3;14) → BCL6 (cell cycle regulator)
– Other associations: BCL2 (anti-apoptotic), MYC translocation (“double-hit” or “triple-hit” lymphomas, poorer prognosis)
- 🦠 May arise de novo or from transformation of low-grade lymphomas (e.g. follicular lymphoma → “Richter’s transformation”)
🩺 Clinical Features
- 🧩 Painless lymphadenopathy (most common presentation)
- 🩸 B symptoms: fever, night sweats, weight loss
- 🫁 Primary mediastinal presentation → cough, breathlessness, SVC obstruction
- 🦠 Intra-abdominal disease → nausea, vomiting, altered bowel habit, abdominal pain/mass
- 🧬 Extranodal involvement: CNS, bone marrow, testis, paranasal sinuses, GI tract
🔎 Investigations
- 🩸 Baseline: FBC, U&E, LFTs, LDH, CRP, ESR, β2-microglobulin
- 🔬 Excisional lymph node biopsy = diagnostic gold standard
- 🖥️ Staging: CT or PET-CT (Ann Arbor staging system)
- 🧪 CSF cytology if CNS involvement suspected or high-risk extranodal sites
⚠️ Poor Prognostic Factors (IPI score)
- 👴 Age >60 years
- 📊 Advanced stage (III or IV disease)
- ⬆️ High serum LDH
- 🌍 >1 extranodal site
- ⚖️ ECOG performance status ≥2
💊 Management
- ⚡ Start treatment promptly after diagnosis; curative intent in most fit patients
- 🌟 Low-risk localised disease: CHOP-R × 3–4 cycles + involved-field radiotherapy
- 🌟 Standard: CHOP-R (cyclophosphamide, doxorubicin, vincristine, prednisolone + rituximab) for 6–8 cycles
- ☢️ Radiotherapy: in advanced disease responding to first-line immunochemotherapy
- 💉 CNS prophylaxis (intrathecal methotrexate) for: high IPI score, testis, breast, paranasal sinus, or bone marrow involvement, HIV-positive patients
🔄 Salvage Therapy & Consolidation
- 💉 Relapsed/refractory disease: multi-agent immunochemotherapy (e.g. R-GDP: rituximab, gemcitabine, dexamethasone, cisplatin) – effective and less toxic than older regimens
- 🧬 Autologous stem cell transplantation: for chemosensitive disease (partial or complete response to salvage)
- 🧬 Allogeneic stem cell transplantation: in relapse post-autologous transplant or where autologous harvest not possible
📚 References
