Diffuse Large B-Cell Lymphoma (DLBCL)

Overview:

• Most common subtype of non-Hodgkin lymphoma (NHL)
• Aggressive but potentially curable with prompt treatment
• Derived from mature B cells

Pathology & Subtypes:

• Large B-cells with diffuse growth pattern
• Subtypes (by gene expression profiling):
  • GCB (Germinal Center B-cell)
  • ABC (Activated B-cell) – worse prognosis
  • Double-hit/triple-hit lymphoma – involving MYC, BCL2, BCL6 rearrangements (high risk)

Clinical Features:

• Rapidly enlarging lymph node mass (usually neck, abdomen, mediastinum)
• B symptoms: fever, weight loss, night sweats
• Extranodal involvement: CNS, GI, bone marrow, testis, etc.

Diagnosis:

• Excisional lymph node biopsy (gold standard)
• Immunohistochemistry: CD20+, BCL6+, MUM1, CD10
• Staging: PET-CT, bone marrow biopsy
• Molecular studies: FISH for MYC/BCL2/BCL6

Staging: Ann Arbor system (I–IV)

Treatment:

• Frontline:
  • R-CHOP (standard for most cases)
  • Pola-R-CHP: an option in newly diagnosed high-risk cases
  • G-CHOP: sometimes used
• Relapsed/Refractory:
  • R-ICE, R-DHAP for transplant-eligible
  • CAR-T cell therapy (e.g., Tisagenlecleucel)
  • Polatuzumab + bendamustine + rituximab (Pola-BR)
  • Antibody-drug conjugates or BTK inhibitors in select cases

Pharmacist Considerations:

• CD20-targeted therapy monitoring: premeds, infusion reactions
• Myelosuppression: growth factor support, infection risk
• Cardiotoxicity: anthracycline use
• Neuropathy: vincristine or polatuzumab
• Hepatitis B screening before anti-CD20 therapy
• Monitor renal/hepatic function, electrolytes, and tumor lysis risk