Diffuse large B-cell lymphoma
Diffuse large B-cell lymphoma is one of the most common B-cell non-Hodgkin’s lymphomas (B-NHL). It accounts for roughly 40% of all cases of lymphoma, a reflection that the disease label is a broad umbrella for a heterogenous group of high grade lymphomas.
Like the other common B-NHL, follicular lymphoma, diffuse large B-cell lymphomas are dependent on the inflammatory tumour micro-environment for their proliferation and growth. It can be further sub-classified by its tumour genetics which can be correlated with prognosis.
Diffuse large B-cell lymphoma (DLBCL) is associated with a ten times increased risk of prior exposure to Q fever but several other infections are known to predispose, such as Epstein-Barr virus exposure, as well as genotype and interventions such as organ transplantation.
The WHO 'blue book' includes an extensive sub-classification.
The main sub-groups are:
- Activated B cell-like diffuse large B-cell lymphoma ((ABC) DLBCL, sometimes (non-GCB) DLBCL)
- Germinal center B-cell-like diffuse large B-cell lymphoma ((GCB) DLBCL)
- Expresses genes that are hallmarks of normal germinal center B-cells such as BCL-6
- Best prognosis with classic treatments
- Primary mediastinal B cell lymphoma (PMBL)
- First recognised as a rarer lymphoma in young adults
- 75% share genetic markers with Hodgkins lymphoma, the rest are either (GCB) DLBCL or (ABC) DLBCL
Current multi-agent chemotherapy regimes can cure over 40%.
- CHOP-like chemotherapy such as cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).
- Standard regime six cycles of R-CHOP every 21 days (R-CHOP21)
- Lenalidomide as third line
- ↑ Staudt LM, Dave S. The biology of human lymphoid malignancies revealed by gene expression profiling. Advances in immunology. 2005; 87:163-208.(Link to article – subscription may be required.)
- ↑ Melenotte C, Million M, Audoly G, Gorse A, Dutronc H, Roland G, Dekel M, Moreno A, Cammilleri S, Carrieri MP, Protopopescu C, Ruminy P, Lepidi H, Nadel B, Mege JL, Xerri L, Raoult D. B-cell non-Hodgkin lymphoma linked to Coxiella burnetii. Blood. 2016 Jan 7; 127(1):113-21.(Link to article – subscription may be required.)
- ↑ Hussain SK, Makgoeng SB, Everly MJ, Goodman MT, Martínez-Maza O, Morton LM, Clarke CA, Lynch CF, Snyder J, Israni A, Kasiske BL, Engels EA. HLA and Risk of Diffuse Large B-cell Lymphoma After Solid Organ Transplantation. Transplantation. 2015 Dec 4.(Epub ahead of print) (Link to article – subscription may be required.)
- ↑ Sonet A, Bosly A. Rituximab and chemotherapy in diffuse large B-cell lymphoma. Expert review of anticancer therapy. 2009 Jun; 9(6):719-26.(Link to article – subscription may be required.)
- ↑ Fang C, Zhu D, Dong H, Ji M, Wu J, Xu X, Cheng G, Wu C, Jiang J. Lenalidomide alone or in combination with chemotherapy treatment for subtypes of diffuse large B cell lymphoma: a systematic review and meta-analysis. International journal of clinical and experimental medicine. 2015; 8(7):10705-13.(Epub)
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