Official websites use. Share sensitive information only on official, secure websites. Address reprint requests to Dr. Patients typically present with progressive lymphadenopathy, extranodal disease, or both and require therapy. Patients with treatment failure after R-CHOP often have a poor outcome — in particular, those with disease that is refractory to frontline or subsequent therapies — although some patients can have a durable remission and be cured after secondary therapies.
Over the past two decades, improved insights into large B-cell lymphomas, in terms of epidemiology, prognostic factors, and biologic heterogeneity, have led to a refinement of disease classification and the development of new therapeutic approaches. Diagnosis of large B-cell lymphomas relies on a detailed examination of tumor tissue, best achieved with an excisional biopsy specimen evaluated by an expert hematopathologist. Biopsy specimens obtained by fine-needle aspiration are inadequate for pathological assessment.
Although specimens from core biopsy are frequently used, they are often insufficient for a complete evaluation, and core biopsy should be performed only if excisional biopsy is not feasible.
A detailed review of each disorder is beyond the scope of this article, and thoughtful management often requires consultative review. Also, since clinical management of these rare entities may evolve rapidly, with new therapies under investigation in clinical trials, consultation with a hemato-oncologist specializing in lymphoid cancer is recommended. The standard regimen for many of these entities continues to be R-CHOP rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone , although rituximab would be omitted in patients with lymphomas that are CDnegative.
Follicular lymphoma grades 3A and 3B also contain a variable but substantial proportion of large B cells; although treatment for follicular lymphoma grade 3B is commonly the same as treatment for DLBCL, it is not included in this table.
