Limited‐stage diffuse large B‐cell lymphoma: current management and challenges. (22nd February 2021)

• Record Type: Journal Article
• Authors: Zhang, Xiao‐Yin; Collins, Graham P.; Cutter, David J.; Eyre, Toby A.
• Is Part Of: British journal of haematology. Volume 194:Number 3(2021)
• Page Start: 508
• Page End: 517
• Publication Date: 2021-02-22
• Subjects: DLBCL -- limited stage -- radiotherapy -- PET -- clinical trials; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.17359
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: Twenty‐five to thirty per cent of diffuse large B‐cell lymphoma (DLBCL) presents as limited stage (I–II). Prognosis is generally excellent with four to six cycles of R‐CHOP alone (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisolone) or combined‐modality therapy with three or four cycles and involved‐site radiotherapy (RT). There is growing interest in optimising algorithms to retain disease control whilst minimising long‐term toxicity, with several recent studies focusing on the safety of abbreviating chemotherapy and omitting RT in low‐risk patients and the utility of PET‐based response‐adapted approaches. As these studies are limited to younger patients without risk factors, application of similar approaches in elderly or higher‐risk patients is hampered by a lack of evidence. Whilst there has been a move away from using RT in low‐risk patients, it remains a useful adjunct in specific situations. Current evidence cannot exclude a clinically meaningful benefit from RT even in low‐risk patients and, given the low expected toxicity from modern RT techniques, a risk–benefit assessment should be individualised and considered in a multidisciplinary fashion. The optimal approach for extranodal limited‐stage DLBCL (~40% of cases) varies according to site of origin. Herein we discuss the latest clinical trial evidence and how this can be applied in routine practice.