Treatment of diffuse large B-cell lymphoma (DLBCL)
The physician will assign an individualized treatment plan depending on the specific staging and stage of the patient’s disease, the patient’s personal health status, and other factors.
Induction therapy.
Once diffuse large B-cell lymphoma (DLBCL) is diagnosed, the first treatment received is induction therapy. The goal of induction therapy is to cure or achieve remission. Induction therapy usually includes: chemotherapy and immunotherapy.
Radiation therapy.
Sometimes radiation therapy is given to the patient after induction therapy, sometimes at the same time.
Maintenance therapy.
Maintenance therapy for DLBCL is still in the experimental stage and is not yet widely used.
If these treatments do not work, or if the disease relapses, further treatment will be used, and doctors will try to increase the dose of chemotherapy and perform a stem cell transplant. If treatment is not successful, the ultimate goal will be to control symptoms and relieve pain.
Immunotherapy
The most commonly used immunotherapy drug as part of induction therapy is the monoclonal antibody, which is a relatively new drug. The use of monoclonal antibodies is a major advance in the history of DLBCL treatment.
How do monoclonal antibodies work?
Unlike traditional treatments, immunotherapy mainly mobilizes the body’s natural ability to fight cancer, restores immunity to immunodeficient patients, and prevents immunosuppression caused by surgery, radiotherapy or chemotherapy, thus exerting an anti-tumor effect. Monoclonal antibodies are molecularly targeted tumor treatments, which target and selectively bind to these oncogenic sites after entering the body and cause specific death of tumor cells, while having very little effect on normal tissue cells surrounding the tumor and significantly reducing adverse effects.
Rituximab: A monoclonal antibody proven to be safe and effective in the treatment of lymphoma, it is the most representative targeted therapy drug. It is generally used in combination with chemotherapy in clinical applications (except for patients with poor general condition, intolerance to chemotherapy or maintenance treatment with rituximab after disease remission), for example, the first-line treatment regimen for diffuse large B-cell lymphoma is CHOP + rituximab or EPOCH + rituximab. For optimal treatment, 8 courses of rituximab are usually used.
Advantages of Rituximab: It specifically binds closely to malignant B-lymphocytes expressing CD20 and targets tumor cells to exert anti-tumor effects, while having very little effect on normal tissue cells surrounding the tumor. Due to the special mechanism of action of targeted drugs, they rarely injure normal cells and produce less side effects that are difficult for patients to tolerate. Even if some symptoms occur, they are usually mild and can be treated with symptomatic treatment.
Rituximab, an anti-CD20 monoclonal antibody, combined with CHOP therapy can significantly improve the cure rate of DLBCL patients. Currently, the widely accepted first-line standard treatment regimen for DLBCL remains rituximab + CHOP-21.
Maintenance therapy
Maintenance therapy is administered after successful induction therapy using immunotherapy. Maintenance therapy has been shown to be beneficial in some DLBCL, and maintenance therapy for DLCBL is still in the experimental phase and not yet widely used.
The goal of maintenance therapy is to maximize the patient’s asymptomatic survival and to further delay disease progression.
Maintenance therapy is the continuation of immunotherapy with monoclonal antibodies, but maintenance therapy does not require receiving any traditional chemotherapy. Maintenance chemotherapy is usually given for eight cycles, and the physician will develop a maintenance regimen based on the patient’s individual circumstances.