ANDY(DAVIES((SOUTHAMPTON)
FIRST(LINE((
(
University(of(Southampton,(UK(
!
This!presentation!uses!a!case>based!approach!to!discuss!the!modern!management!of!DLBCL.!
In!the!first!section!early!stage!disease!is!discussed.!Largely!the!prognosis!is!good!for!these!
patients! and! there! has! been! a! move! to! reduce! radiotherapy! and! a! minimisation! of!
chemotherapy!cycles.!PET!based!approaches!are!guiding!risk!stratification.!In!those!patients!
with!advanced!stage!disease!R>CHOP!remains!the!standard!of!care!despite!many!attempts!to!
improve! outcomes.! There! is! some! variation! in! practice! according! to! territories! and! this! is!
reflected! in! the! ESMO! guidelines.! Biological! stratification! of! patients! with! targeted!
interventions!in!addition!to!R>CHOP!has!failed!to!improve!outcomes!but!this!is!likely!a!result!
of!complex!molecular!heterogeneity!in!DLBCL.!
The! approach! to! CNS! prophylaxis! has! evolved! over! the! last! few! years.! We! are! better! at!
identifying!those!patients!at!increased!risk!and!recognise!that!intrathecal!chemotherapy!is!
largely! ineffective.! Furthermore,! 70%! of! events! with! be! brain! parenchymal! lesions.!
Intravenous!methotrexate!has!become!the!standard!approach!and!delivery!with!at!the!end!
of!induction!or!intercalated!will!be!discussed.!
(
Bibliography:(
A! Probabilistic! Classification! Tool! for! Genetic! Subtypes! of! Diffuse! Large! B! Cell! Lymphoma! with!
Therapeutic!Implications.!
Wright!GW,!Huang!DW,!Phelan!JD,!Coulibaly!ZA,!Roulland!S,!Young!RM,!Wang!JQ,!Schmitz!R,!Morin!
RD,!Tang!J,!Jiang!A,!Bagaev!A,!Plotnikova!O,!Kotlov!N,!Johnson!CA,!Wilson!WH,!Scott!DW,!Staudt!LM.!
Cancer!Cell.!2020!Apr!13;37(4):551>568.e14.!doi:!10.1016/j.ccell.2020.03.015.!
!
Obinutuzumab! or! Rituximab! Plus! Cyclophosphamide,! Doxorubicin,! Vincristine,! and! Prednisone! in!
Previously!Untreated!Diffuse!Large!B>Cell!Lymphoma.!
Vitolo!U,!Trněný!M,!Belada!D,!Burke!JM,!Carella!AM,!Chua!N,!Abrisqueta!P,!Demeter!J,!Flinn!I,!Hong!X,!
Kim! WS,! Pinto! A,! Shi! YK,! Tatsumi! Y,! Oestergaard! MZ,! Wenger! M,! Fingerle>Rowson! G,! Catalani! O,!
Nielsen!T,!Martelli!M,!Sehn!LH.!
J!Clin!Oncol.!2017!Nov!1;35(31):3529>3537.!doi:!10.1200/JCO.2017.73.3402.!Epub!2017!Aug!10.!
!
Diffuse! large! B>cell! lymphoma! (DLBCL):! ESMO! Clinical! Practice! Guidelines! for! diagnosis,! treatment!
and!follow>up.!
Tilly! H,! Gomes! da! Silva! M,! Vitolo! U,! Jack! A,! Meignan! M,! Lopez>Guillermo! A,! Walewski! J,! André! M,!
Johnson!PW,!Pfreundschuh!M,!Ladetto!M;!ESMO!Guidelines!Committee.!
Ann!Oncol.!2015!Sep;26!Suppl!5:v116>25.!doi:!10.1093/annonc/mdv304.!
!
Autologous!transplantation!as!consolidation!for!aggressive!non>Hodgkin's!lymphoma.!
Stiff!PJ,!Unger!JM,!Cook!JR,!Constine!LS,!Couban!S,!Stewart!DA,!Shea!TC,!Porcu!P,!Winter!JN,!Kahl!BS,!
Miller!TP,!Tubbs!RR,!Marcellus!D,!Friedberg!JW,!Barton!KP,!Mills!GM,!LeBlanc!M,!Rimsza!LM,!Forman!
SJ,!Fisher!RI.!
N!Engl!J!Med.!2013!Oct!31;369(18):1681>90.!doi:!10.1056/NEJMoa1301077.!
!
Continued!Risk!of!Relapse!Independent!of!Treatment!Modality!in!Limited>Stage!Diffuse!Large!B>Cell!
Lymphoma:!Final!and!Long>Term!Analysis!of!Southwest!Oncology!Group!Study!S8736.!