Fast Five Quiz: Diffuse Large B-Cell Lymphoma

Medscape

a day ago

Although diffuse large B-cell lymphoma (DLBCL) is characterized by aggressive clinical behavior, standard treatment can provide good long-term survival outcomes. However, management can be complex, with certain comorbidities exacerbating disease severity and complications such as extranodal involvement significantly affecting prognosis. Understanding the nuances of DLCBL presentation, diagnosis, and management is key to delivering the best outcomes to patients affected by this rapidly progressive disease.
What do you know about DLBCL? Check your knowledge with this quick quiz.
Both primary and secondary Sjögren syndrome are strongly associated DLBCL. Other autoimmune disorders that have been associated with DLBCL include hemolytic anemia, rheumatoid arthritis, systemic lupus erythematosus, and Crohn's disease. In addition to autoimmune disorders, viral infections have also been linked to DLBCL; these include HIV, hepatitis B, hepatitis C, and Epstein-Barr. Further, data have shown that patients with rheumatic diseases have a heightened risk of DLBCL development.
Though fugal or bacterial pneumonia, humoral deficiency, and bone infections (such as osteomyelitis) can occur in patients with DLBCL, data have indicated that survivors of DLBCL were more likely to experience these conditions, rather than being strongly linked to DLBCL itself.
Learn more about DLBCL staging.
In the NCCN's guidelines, PET/CT is the preferred modality for imaging in DLBCL workup. C/A/P CT with contrast can also be used in a complementary setting to help stage the disease and identify other factors such as extranodal disease or visceral involvement, but it is not preferred. Although not essential, head CT/MRI or neck CT/MRI with contrast (as well as bone marrow biopsy) can be useful for workup in selected cases. Specifically, bone marrow biopsy can be helpful in identifying indolent or low-volume disease. However, the NCCN notes that bone marrow biopsy is not needed if PET/CT shows bone disease.
Learn more about DLBCL workup.
Data indicate that extranodal involvement occurs in approximately 30%– 50% of patients with DLBCL; further, it is reported that gastrointestinal involvement is the most common extranodal site. Other affected sites include the skin, bones, spleen, and central nervous system; kidneys, testicles, and the liver can also be impacted, but they are not regarded as the most common.
Learn more about DLCBL and extranodal involvement.
A population-based study involving over 30,000 patients with extranodal DLBCL found that the best outcomes are associated with heart and mediastinal sites, with a 42% reduction in mortality risk compared with involvement of the intestinal tract.
Involvement of the pancreas and hepatobiliary system, respiratory system, or nervous system are associated with significantly greater risks of mortality compared with the intestinal tract. Other factors associated with greater mortality risk include late age at onset, history of other malignancy, late age at presentation, and Black, non-Hispanic ethnicity.
Learn more about DLBCL prognosis.
CAR T therapy is typically utilized as a second-line treatment for patients with relapsed/refractory DLBCL. CD19-directed CAR T-cell therapy is considered ' the standard of care' for relapsed/refractory DLBCL, with three treatments approved for this population. Although a number of factors can lead to CAR T cell therapy resistance, the key mechanism is typically down regulation or loss of CD19 expression.
Abnormal differentiation and dysfunction of T cells can also cause poor response to CAR T therapy, and being unable to collect enough T cells can also negatively affect the impact of CAR T products; however, these factors are not considered key mechanisms for resistance to CAR T-cell therapy. As such, early collection of T-cells in high-risk patients with DLBCL is one strategy to ensure enough T cells are available when needed. Partial response or relapse after CAR T therapy should prompt third-line therapy, such as alternative systemic therapy not previously given, clinical trial, palliative involved-site radiation therapy, or best supportive care.
Learn more about relapsed or refractory DLBCL.