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Review
. 2021 Aug;194(3):508-517.
doi: 10.1111/bjh.17359. Epub 2021 Feb 22.

Limited-stage diffuse large B-cell lymphoma: current management and challenges

Xiao-Yin Zhang  1 , Graham P Collins  1 , David J Cutter  2   3 , Toby A Eyre  1
Affiliations
Review

Limited-stage diffuse large B-cell lymphoma: current management and challenges

Xiao-Yin Zhang et al. Br J Haematol. 2021 Aug.

Abstract

Twenty-five to thirty per cent of diffuse large B-cell lymphoma (DLBCL) presents as limited stage (I-II). Prognosis is generally excellent with four to six cycles of R-CHOP alone (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisolone) or combined-modality therapy with three or four cycles and involved-site radiotherapy (RT). There is growing interest in optimising algorithms to retain disease control whilst minimising long-term toxicity, with several recent studies focusing on the safety of abbreviating chemotherapy and omitting RT in low-risk patients and the utility of PET-based response-adapted approaches. As these studies are limited to younger patients without risk factors, application of similar approaches in elderly or higher-risk patients is hampered by a lack of evidence. Whilst there has been a move away from using RT in low-risk patients, it remains a useful adjunct in specific situations. Current evidence cannot exclude a clinically meaningful benefit from RT even in low-risk patients and, given the low expected toxicity from modern RT techniques, a risk-benefit assessment should be individualised and considered in a multidisciplinary fashion. The optimal approach for extranodal limited-stage DLBCL (~40% of cases) varies according to site of origin. Herein we discuss the latest clinical trial evidence and how this can be applied in routine practice.

Keywords: DLBCL; PET; clinical trials; limited stage; radiotherapy.

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