Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, making up 30-40% of cases. DLBCL is an aggressive or intermediate-grade lymphoma characterized by large malignant B cells. Risk factors include family history of lymphoma, autoimmune disease, HIV/HCV infection, and high body mass index. Treatment involves chemotherapy such as R-CHOP along with radiation or stem cell transplant depending on risk factors and age. Prognosis depends on factors like stage and the international prognostic index, with 5-year survival rates around 46% on average.

1. DIFFUSE LARGE B-CELL LYMPHOMA
DLBCL

2. *most common type of non-Hodgkin lymphoma (30-
40%)
* aggressive or intermediate-grade lymphoma

4. neoplastic cells are predominantly large Cells with vesicular
chromatin and prominent nucleoli.

5. RISK FACTORS
family history of lymphoma
autoimmune disease
human immunodeficiency virus (HIV) infection
hepatitis C virus (HCV) seropositivity
high body mass as a young adult and
occupational exposure

6. Epstein-Barr virus - Primary CNS diffuse large B cell
lymphoma
Human herpes virus 8 – primary effusion lymphoma

7. CYTOGENETICS
t(3;-)(q27;-) BCL-6
t(17;-)(p13;-) p53
“double-hit” lymphomas - typically more aggressive
growth and poor response

9. MEDIAN AGE : 64 years
FREQUENCY IN CHILDREN : 25% of childhood NHL
% IN MALES : 55%
5 YEARS SURVIVAL RATE : 46%
CLINICAL PRESENTATION

10. present as either primary lymph node disease or at extra nodal
sites (50%)
m/c extranodal site – GIT, BONE MARROW (15-20%)
OTHER SITES – PANCREAS , BRAIN,
OTHER UNUSUAL SUBTYPES : pleural effusion lymphoma ,
intravascular lymphoma

12. surgical excision biopsy
*allows assessment of nodal architecture and provides adequate material for
phenotypic and molecular studies.
*suggested immunohistochemical panel
CD20, CD79a, BCL6, CD10, MYC, BCL2, Ki67, IRF4, CyclinD1, CD5,
CD23, and EBER-1 staining

13. STAGING EVALUATION
*Physical examination
*Documentation of B symptoms
*Laboratory Evaluation
Complete blood counts
Liver function tests
Uric acid, Calcium, LDH
Serum protein
Electrophoresis
Serum ß2-microglobulin

14. Chest radiograph
CT scan of abdomen, pelvis and chest
Bone marrow biopsy
Lumbar puncture in diffuse large B-cell lymphoma with positive
marrow biopsy
Gallium scan (SPECT) or FDG-PET scan
MRI
screening tests for HIV, HBV and HCV

15. ANN ARBOR STAGING
Stage
I Involvement of a single lymphatic region (I) or localized involvement of
single extra lymphatic organ or site (IE)
II Involvement of two or more lymphatic regions on the same side of the
diaphragm (II) or localized involvement of a single extra lymphatic organ or site
and of one or more lymphatic regions on the same side of the diaphragm (IIE)
III Involvement of lymphatic regions on both sides of the diaphragm
IV Diffuse or disseminated involvement of one or more extra lymphatic
organs with or without lymphatic involvement

16. International prognostic index (IPI) Estimated 3-year overall survival

17. International prognostic index (IPI) Estimated 3-year overall survival

18. TREATMENT STRATEGIES
*young low-risk patients (aa-IPI=0)without bulky disease
R-CHOP21×6
*young low-intermediate-risk patients (aa-IPI=1) or IPI low risk (aa-IPI=0)
with bulky disease
(R)-CHOP 21×6 with IF-radiotherapy
OR
R-ACVBP with sequential consolidation
*young high-and high-intermediate-risk patients (aa-IPI≥2)
R-CHOP21×6–8
or
R-CHOP14×6 with 8 R
or
(R-CHOEP14×6 or R-CHOP or R-ACVBP plus HDCT with ASCT)

19. *patients aged 60–80years,fit
R-CHOP21×6–8 (R-CHOP21×6 for IPI low risk)
or
R-CHOP14×6 with 8R
*Unfit or frail or >60 years with cardiac dysfunction
R-C(X)OP21×6 (Doxorubicin substitution with gemcitabine, etoposide or liposomal doxorubicin)
or palliative care

20. - high-intermediate and high-risk IPI, especially those with more than
one extra nodal site or elevated LDH, are at higher risk of CNS
relapse.
- Testicular, renal and adrenal involvements have been validated as
additional risk factors.
- MYC gene rearrangement is associated with a high risk of CNS relapse
- Although widely used, intrathecal injections of methotrexate may
not be an optimal method. Intravenous high dose methotrexate has
been shown to be associated with efficient disease control.
Central nervous system (CNS) prophylaxis

21. post-treatment evaluation
* FDG-PET/CT - recommended for post-treatment assessment

24. follow-up
*Careful history and physical examination every 3 months for 1 year, every 6
months for 2 further years and then once a year.
* Blood count should be carried out at 3, 6, 12 and 24 months, then only as
needed for evaluation of suspicious symptoms or clinical findings in those
patients suitable for further therapy.
* Minimal radiological examinations at 6, 12 and 24 months after end of
treatment by CT scan is common practice.

26. Thank you……