Diffuse Large B-Cell Lymphoma DLBCL

DLBCL is the most common type of aggressive non-Hodgkin lymphoma, arising from B-lymphocytes. It can develop in lymph nodes or in organs such as the stomach, brain, or bone. It grows rapidly but is often curable with prompt, appropriate treatment — particularly immunochemotherapy based on rituximab.

GCB (germinal center B-cell) and ABC (activated B-cell) are the two main molecular subtypes of DLBCL, identified by gene expression profiling. GCB DLBCL generally has a better prognosis and different genetic drivers (BCL2 translocation, EZH2 mutations) compared to ABC DLBCL, which has NF-κB pathway activation and mutations in MYD88 and CD79B. This distinction influences treatment decisions, especially for novel targeted therapies.

Double-hit lymphoma refers to high-grade B-cell lymphoma with concurrent rearrangements of MYC and BCL2 (or BCL6) genes, detected by FISH testing. These are more aggressive than typical DLBCL and often require more intensive treatment than standard R-CHOP. Triple-hit lymphoma involves all three gene rearrangements and is even more aggressive.

R-CHOP remains the most widely used first-line treatment, but it is not the only option. Patients with high-risk features (double-hit, high IPI) may receive DA-EPOCH-R or R-CHOP plus polatuzumab vedotin (Pola-R-CHP). In relapsed disease, salvage chemotherapy, autologous stem cell transplant, CAR-T cell therapy, and bispecific antibodies (epcoritamab, glofitamab) are established options.

CAR-T (chimeric antigen receptor T-cell) therapy involves genetically engineering a patient's own T-cells to recognise and destroy CD19-positive lymphoma cells. It is approved for relapsed/refractory DLBCL after at least two prior lines of therapy, and in some guidelines for second-line disease. Eligibility depends on disease status, organ function, and performance status. CancerFax can help determine eligibility and coordinate access.

Bispecific antibodies (epcoritamab, glofitamab) simultaneously bind CD20 on lymphoma cells and CD3 on T-cells, bringing them together to kill the cancer without requiring cell collection and manufacturing. They are administered off-the-shelf (no waiting time) and are approved for R/R DLBCL, making them important for patients not suitable for CAR-T or who need a faster option.

Relapsed or refractory DLBCL is treated with platinum-based salvage chemotherapy (R-ICE, R-DHAP) if transplant-eligible, followed by autologous stem cell transplant in chemosensitive patients. For patients who are not transplant candidates or who relapse again, CAR-T cell therapy, bispecific antibodies, or clinical trial enrolment are the key strategies. Early referral to a specialist centre is strongly recommended.

CNS involvement in DLBCL can occur at diagnosis (primary CNS DLBCL) or as CNS relapse during or after treatment. Patients with high CNS-IPI scores, testicular, renal/adrenal involvement, or certain molecular features receive prophylactic intrathecal or intravenous methotrexate. Primary CNS DLBCL is treated with methotrexate-based regimens rather than standard R-CHOP.

Yes. CancerFax provides DLBCL patients with molecular report review, second opinion coordination with international haematology and lymphoma specialists, and structured access to CAR-T cell therapy programs, bispecific antibodies, and clinical trials — including advanced therapies available through centres in China, India, and globally. Whether you are newly diagnosed, at first relapse, or seeking options after multiple lines of therapy, our team can help identify the most appropriate pathway for your specific subtype and stage.